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J. T. Lehner - One of the best experts on this subject based on the ideXlab platform.
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Immediate Hip Spica Casting for femur fractures in pediatric patients. A review of 175 patients.
Clinical orthopaedics and related research, 2000Co-Authors: A. F. Infante, M. C. Albert, W. B. Jennings, J. T. LehnerAbstract:Abstract Immediate closed reduction and application of a well-molded Hip Spica Cast is a safe and effective treatment option for closed, isolated femur fractures in children who weigh between 10 and 100 pounds. Between 1988 and 1996, 190 immediate Hip Spica Casts were placed on children with isolated femoral shaft fractures who weight between 10 and 100 pounds. Fifteen patients were lost to followup leaving 175 children who were evaluated and followed up for at least 2 years after the Hip Spica Cast was removed (range 2-10 years). The femur fractures were reduced closed and placed in a 1 1/2 Hip Spica Cast in the emergency room with the patient under conscious sedation or in the operating room with the patient under general anesthesia. All of the children returned home within 24 hours of the procedure. All 175 femur fractures united within 8 weeks. The only complication was a refracture in a 25 pound child who fell 1 week after the Cast was removed. No significant residual angular deformities were present in any of the children at last followup. None of the children required external shoe lifts, epiphysiodesis, antibiotics, irrigation and debridements, or limb lengthening procedures for leg length inequalities. The authors think that immediate closed reduction and placement of a well-molded Hip Spica Cast is a safe and reliable treatment option for isolated, closed femur fractures in children from birth to 10 years of age who weigh less than 80 pounds.
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Immediate Hip Spica Casting for femur fractures in pediatric patients : A review of 175 patients : Children's fractures
Clinical Orthopaedics and Related Research, 2000Co-Authors: A. F. Infante, M. C. Albert, W. B. Jennings, J. T. LehnerAbstract:Immediate closed reduction and application of a well-molded Hip Spica Cast is a safe and effective treatment option for closed, isolated femur fractures in children who weigh between 10 and 100 pounds. Between 1988 and 1996, 190 immediate Hip Spica Casts were placed on children with isolated femoral shaft fractures who weighed between 10 and 100 pounds. Fifteen patients were lost to followup leaving 175 children who were evaluated and followed up for at least 2 years after the Hip Spica Cast was removed (range 2-10 years). The femur fractures were reduced closed and placed in a 11/2 Hip Spica Cast in the emergency room with the patient under conscious sedation or in the operating room with the patient under general anesthesia. All of the children returned home within 24 hours of the procedure. All 175 femur fractures united within 8 weeks. The only complication was a refracture in a 25 pound child who fell 1 week after the Cast was removed. No significant residual angular deformities were present in any of the children at last followup. None of the children required external shoe lifts, epiphysiodesis, antibiotics, irrigation and debridements, or limb lengthening procedures for leg length inequalities. The authors think that immediate closed reduction and placement of a well-molded Hip Spica Cast is a safe and reliable treatment option for isolated, closed femur fractures in children from birth to 10 years of age who weigh less than 80 pounds.
A. F. Infante - One of the best experts on this subject based on the ideXlab platform.
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Immediate Hip Spica Casting for femur fractures in pediatric patients. A review of 175 patients.
Clinical orthopaedics and related research, 2000Co-Authors: A. F. Infante, M. C. Albert, W. B. Jennings, J. T. LehnerAbstract:Abstract Immediate closed reduction and application of a well-molded Hip Spica Cast is a safe and effective treatment option for closed, isolated femur fractures in children who weigh between 10 and 100 pounds. Between 1988 and 1996, 190 immediate Hip Spica Casts were placed on children with isolated femoral shaft fractures who weight between 10 and 100 pounds. Fifteen patients were lost to followup leaving 175 children who were evaluated and followed up for at least 2 years after the Hip Spica Cast was removed (range 2-10 years). The femur fractures were reduced closed and placed in a 1 1/2 Hip Spica Cast in the emergency room with the patient under conscious sedation or in the operating room with the patient under general anesthesia. All of the children returned home within 24 hours of the procedure. All 175 femur fractures united within 8 weeks. The only complication was a refracture in a 25 pound child who fell 1 week after the Cast was removed. No significant residual angular deformities were present in any of the children at last followup. None of the children required external shoe lifts, epiphysiodesis, antibiotics, irrigation and debridements, or limb lengthening procedures for leg length inequalities. The authors think that immediate closed reduction and placement of a well-molded Hip Spica Cast is a safe and reliable treatment option for isolated, closed femur fractures in children from birth to 10 years of age who weigh less than 80 pounds.
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Immediate Hip Spica Casting for femur fractures in pediatric patients : A review of 175 patients : Children's fractures
Clinical Orthopaedics and Related Research, 2000Co-Authors: A. F. Infante, M. C. Albert, W. B. Jennings, J. T. LehnerAbstract:Immediate closed reduction and application of a well-molded Hip Spica Cast is a safe and effective treatment option for closed, isolated femur fractures in children who weigh between 10 and 100 pounds. Between 1988 and 1996, 190 immediate Hip Spica Casts were placed on children with isolated femoral shaft fractures who weighed between 10 and 100 pounds. Fifteen patients were lost to followup leaving 175 children who were evaluated and followed up for at least 2 years after the Hip Spica Cast was removed (range 2-10 years). The femur fractures were reduced closed and placed in a 11/2 Hip Spica Cast in the emergency room with the patient under conscious sedation or in the operating room with the patient under general anesthesia. All of the children returned home within 24 hours of the procedure. All 175 femur fractures united within 8 weeks. The only complication was a refracture in a 25 pound child who fell 1 week after the Cast was removed. No significant residual angular deformities were present in any of the children at last followup. None of the children required external shoe lifts, epiphysiodesis, antibiotics, irrigation and debridements, or limb lengthening procedures for leg length inequalities. The authors think that immediate closed reduction and placement of a well-molded Hip Spica Cast is a safe and reliable treatment option for isolated, closed femur fractures in children from birth to 10 years of age who weigh less than 80 pounds.
John M. Flynn - One of the best experts on this subject based on the ideXlab platform.
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The Treatment of Low-Energy Femoral Shaft Fractures: A Prospective Study Comparing the “Walking Spica” with the Traditional Spica Cast
The Journal of bone and joint surgery. American volume, 2011Co-Authors: John M. Flynn, Matthew R. Garner, Kristofer J. Jones, Joann G. D'italia, Richard S. Davidson, Theodore J. Ganley, B. David Horn, David Spiegel, Lawrence WellsAbstract:Background: A single-leg, walking Hip Spica Cast has been shown to be a safe and effective treatment for a low-energy femoral shaft fracture in young children. We designed a prospective cohort trial comparing walking and traditional Hip Spica Casting to determine whether a walking Hip Spica Cast was superior to a traditional Hip Spica Cast following a low-energy femoral shaft fracture in children one to six years old. Methods: We studied forty-five consecutive low-energy femoral shaft fractures during a three-year period in children one to six years old. Three surgeons treated their patients with a walking Hip Spica Cast, and three other surgeons treated their patients with a traditional Spica Cast. Complications and subsequent interventions were recorded prospectively. Caregivers were asked to complete the validated Impact on Family Scale as well as a ten-item questionnaire developed by the authors at the time of Cast removal. Results: Forty-five patients with a low-energy fracture were enrolled in the study. Nineteen patients were treated with a walking Hip Spica Cast and twenty-six, with a traditional Hip Spica Cast. The two cohorts were similar with respect to age, length of hospital stay, time to initial callus formation, and time to fracture union. Two children treated with a traditional Hip Spica Cast and no children in the walking Hip Spica group returned to the operating room for the treatment of spontaneous loss of fracture reduction. Five of the nineteen children treated with a walking Hip Spica Cast and one of the twenty-six treated with a traditional Hip Spica Cast required wedge adjustment of the Cast in the clinic to treat fracture malalignment (p = 0.04). One patient treated with a walking Hip Spica Cast required repeat reduction in the operating room because of overcorrection during wedge adjustment. The malunion rate did not differ significantly between the groups (three of twenty-six in the traditional Hip Spica group compared with none of nineteen in the walking Hip Spica group). All patients treated with a walking Hip Spica Cast were able to crawl in the Cast, and 71% (twelve of seventeen) were able to walk. Use of the traditional Hip Spica Cast resulted in a significantly greater care burden for the family as measured with use of the Impact on Family Scale (43.3 for the traditional Hip Spica group compared with 35.6 for the walking Hip Spica group, p = 0.04). Insurance-funded ambulance transportation was needed for eleven of the twenty-six patients treated with a traditional Hip Spica Cast compared with none of the nineteen patients treated with a walking Hip Spica Cast (p = 0.001). Conclusions: The walking Hip Spica Cast and the traditional Hip Spica Cast resulted in similar orthopaedic outcomes, and the walking Hip Spica Cast resulted in a lower care burden for the family. Surgeons and families should be aware that use of a walking Hip Spica Cast rather than a traditional Hip Spica Cast may be associated with a greater likelihood that wedge adjustment of the Cast will be necessary to treat fracture malalignment. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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displaced fractures of the Hip in children management by early operation and immobilisation in a Hip Spica Cast
Journal of Bone and Joint Surgery-british Volume, 2002Co-Authors: John M. Flynn, K L Wong, G L Yeh, James S Meyer, R S DavidsonAbstract:Fractures of the Hip in children have been associated with a very high rate of serious complications including avascular necrosis (up to 47%) and coxa vara (up to 32%). Over a period of 20 years, we have treated displaced fractures by early anatomical reduction, internal fixation and immobilisation in a Spica Cast to try to reduce these complications. We have reviewed 18 patients who had a displaced non-pathological fracture of the Hip when under 16 years of age. Their mean age at the time of the injury was eight years (2 to 13). They returned for examination and radiography at a mean follow-up of eight years (2 to 17). Each patient had been treated by early (" 24 hours) closed or open reduction with internal fixation and 16 had immobilisation in a Spica Cast. By Delbet's classification, there was one type-I, eight type-II, eight type-III, and one type-IV fractures. There were no complications in 15 patients. Avascular necrosis occurred in one patient (type-III), nonunion in one (type-II, one of the two patients who did not have a Cast) and premature physeal closure in one (type-I). There were no cases of infection or complications as a result of the Cast. Our treatment of displaced Hip fractures in children by early reduction, internal fixation, and immobilisation in a Spica Cast gave reduced rates of complications compared with that of large published series in the literature.
Abhishek Pandit - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of outcome of titanium elastic nailing (TEN) versus Hip Spica Cast in the treatment of femoral shaft fractures in children
International Journal of Orthopaedics Sciences, 2018Co-Authors: Raj Kumar, Anupma Kumari, Abhishek PanditAbstract:Femoral shaft fractures are among the most common pediatric injury and treatment of them carries a lot of controversies. The aim of this study was to compare the outcome of titanium elastic nailing versus Hip Spica Cast in femoral shaft fractures in children. This prospective study was conducted on 40 children of 5 to 15 years of age treated with titanium elastic nail or early Hip Spica Cast for the fracture shaft of femur during July 2016 to October 2017 in the Department of Orthopaedics, R.I.M.S., Ranchi, Jharkhand. Majority of patients in both treatment group were male child with overall boy to girl ratio was 1.85:1. Mean age in titanium elastic nailing group was 9.82 ± 2.99 years and in Spica group was 8.35 ± 2.53 years. RTA was most common mechanism of injury and right limb was more commonly involved in both groups. Union time was less in titanium elastic nailing group (8.80 1.76 week) than Spica group (10.20 2.33 week) (p = 0.039). Patients in titanium elastic nailing group walked with and without support earlier than the Spica Cast group (p = 0.000). Most common complication in titanium elastic nailing group was limb lengthening (50%) followed by mal alignment (40%) while in Spica group it was limb shortening (65%) followed by mal alignment (55%). Overall complication was higher in Spica group. At final analysis, Flynn score was better in titanium elastic nailing group than in Hip Spica group (p = 0.365). Titanium elastic nailing is better method for the management of femoral shaft fractures in children as it results in higher rate of excellent functional outcome with lower incidence of complications.
Adil Surat - One of the best experts on this subject based on the ideXlab platform.
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Treatment of developmental dysplasia of the Hip before walking: results of closed reduction and immobilization in Hip Spica Cast.
The Turkish journal of pediatrics, 2002Co-Authors: Mehmet Cemalettin Aksoy, Ozkoç G, Ahmet Alanay, Muharrem Yazici, Ozdemir N, Adil SuratAbstract:Abstract We retrospectively evaluated 200 Hips of 129 patients with the diagnosis of developmental dysplasia of the Hip treated with closed reduction and Hip Spica Cast. There were 153 female and 47 male Hips in the group. The mean age of the patients at the time of the reduction were six (range. 2-13) months and mean follow-up was 51 (range: 16-240) months. All the patients were treated with closed reduction and were immobilized in Hip Spica Cast. The mean time of immobilization in the Cast was 102 (range: 45-190) days. Avascular necrosis was observed in 15% of the Hips. Clinical and radiological end results of the patients were evaluated with modified McKay criteria and Severin classification. Eighty-two percent of the patients had satisfactory results according to modified McKay criteria and 76% of the patients according to Severin classification. The most important parameters affecting the end result were pre-reduction location of the Hip, pre-operative acetabular index values and avascular necrosis. Based on the results of this study, treatment of developmental Hip dysplasia with closed reduction and Hip Spica Cast is a relatively safe and effective method.
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Treatment of congenital dislocation of the Hip. Results of closed reduction and immobilization in the Hip Spica Cast.
The Turkish journal of pediatrics, 1997Co-Authors: Mehmet Cemalettin Aksoy, Adil SuratAbstract:Treatment of congenital dislocation of the Hip (CDH) by closed reduction and immobilization in the Hip Spica Cast is one of the accepted methods for use in patients under one year of age. We report 74 congenitally dislocated Hips treated with premanipulation skin traction, closed reduction under anesthesia, adductor tenotomy and immobilization in the Hip Spica Cast. Satisfactory results were obtained in 60 Hips. In seven Hips, avascular necrosis of the capital femoral epiphysis was observed with careful management, closed reduction and immobilization in a Spica Cast provides good results for treatment of CDH.