Functional bracing comparable to spica casting for pediatric femoral fractures


David Speers

David Speers

LAS VEGAS — Femoral fracture bracing showed efficacy and was found to be cost-effective when compared with spica casting for the treatment of pediatric diaphyseal femoral fractures, according to data presented here.

“The DF2 is a reasonable alternative to hip spica casting,” David Speers, CPO/L, a certified orthotist and prosthetist at Scheck & Siress in Schaumburg, Illinois, said at the American Orthotic & Prosthetic Association World Congress.

Speers and colleagues compared the treatment of pediatric diaphyseal femoral fractures with a spica cast with a dynamic femoral fracture orthosis (DF2 brace, DF2 LLC). The current standard of care for a child aged 6 months to 5 years who fractures their femur is a spica cast, he said.

“We’re going to look at three things as far as outcomes,” Speers said. “Does it heal the fracture the same way, is there a cost-savings benefit and is there an improved patient satisfaction.”

The retrospective age- and gender-matched study compared the two treatment outcomes between March 2007 and March 2015 of 48 patients treated with femoral fracture bracing (mean age, 1.9 years) and 42 patients treated with hip spica casting (mean age, 3.5 years). The mean follow-up was 3.6 years. Subjective clinical outcomes, radiographic outcomes and economic outcomes were measured.

Researchers found no difference in satisfaction measures for the orthotic and spica cast techniques. Overall, 100% of respondents said they would use the orthosis again for a similar fracture, while 12% said they would use the spica cast again. There also was no difference in shortening between the treatments.

“Both techniques provided adequate control of fracture displacements,” the researchers wrote.

The mean cost of the femoral fracture orthosis cohort was $4,855 while the mean cost of treatment with spica cast was $12,818, which included anesthesia costs.

Speers reported spica cast treatment has been the definitive treatment for a long time, is used for 4 weeks to 6 weeks and allows patients circumferential immobilization. The technique also has reports of skin and soft-tissue issues.

The functional fracture orthosis is lightweight, customizable based on the age of the child, and easy to clean. It is also easy to change the fracture alignment with the orthosis, he said.

The orthotic protocol included the orthosis being put on the next day at the hospital or during an outpatient visit. The orthosis can be removed at 6 weeks for weight-bearing activity and full activities generally resume at 3 months, according to Speers. – by Bruce Thiel


Speers D. Functional bracing for treatment of pediatric diaphyseal femoral fractures: An alternative to spica casting? Presented at: American Orthotic & Prosthetic Association World Congress; Sept. 6-9, 2017; Las Vegas.

Speers reports being a member of DF2 LLC, which has a tentative distribution agreement with Spinal Technologies to distribute the DF2 brace.

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