JOHNS HOPKINS (US) — Young children with hip and thigh fractures, traditionally given casts on both legs, heal just as well and in greater comfort with single-leg casts, research shows.
Casting both legs and hips has long been thought the only way to assure proper healing and pelvic immobilization in young children who wiggle around and are in perpetual motion. Not so, the new study, published in the Journal of Bone & Joint Surgery, shows.
“The single-leg approach not only appears to be just as effective and safe as double-leg casting in terms of healing, but also it makes the child’s life much easier and requires less complicated daily care,” says senior investigator Paul Sponseller, director of pediatric orthopedics at Johns Hopkins University.
Surgical repair is the treatment of choice for hip and thigh fractures in older children, but those younger than 6 do better with casting only, the investigators say. The American Academy of Orthopaedic Surgeons recently recommended casting as the first line of treatment for children 5 and younger to avoid general anesthesia and surgical complications.
The double cast immobilizes the hips and thighs so that bones or tendons can heal properly, but it can also be cumbersome and uncomfortable. Casting can restrict motion and cause skin problems, aches and pains, increased muscle pressure, and reduced blood flow to nerves and tissue. Casting also requires more complex daily maintenance by parents and other caregivers.
Twenty-eight of the 52 children in the Johns Hopkins study were randomly assigned to get double-leg casts, while the remainder got single-leg casts. The researchers monitored bone healing with bi-weekly X-rays. They used questionnaires to gauge ease of care for parents and the child’s comfort and physical functioning.
While children in both groups healed equally well and without any major complications, those in single-leg casts reported greater comfort and mobility, fit more easily in car seats, got dressed more easily and sat more comfortably in chairs. Parents and caregivers of children in single-leg casts reported taking, on average, eight fewer days off from work.
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