Overgrowth and outcome after femoral shaft fracture in children younger than 2 years

Twenty-one children younger than 2 years with a fractured femur were evaluated retrospectively to determine limb overgrowth, efficacy, and outcome after treatment with immediate spica casting. All children had spica casts placed without general anesthesia within 24 hours of admission. Followup averaged 51 months (range, 24-110 months). Average shortening in the spica cast at initial application was 0.5 cm (range, 0-1.8 cm). The average length of hospitalization was 2.2 days. Three patients went home the same day, and seven were discharged after a single overnight stay in the hospital. No patients underwent closed manipulation or a cast change for malalignment of the fracture. Child abuse was identified as the mechanism of injury in eight of 12 (67%) children younger than 1 year of age and in only one of nine (11%) children between 1 and 2 years of age. Leg lengths were determined by measurement with tape and graduated blocks. At followup, the average limb length inequality was 0 cm, with an average net growth of 0.5 cm (range, - 0.5-1.8 cm). Only one child had a limb length inequality of more than 1 cm as measured with tape (20 months of age), and no child had a limb length inequality of more than 1 cm as measured with blocks. No child or parent reported any residual pain, limp, or limitation of activity. The results of this study suggest that overgrowth does occur in children younger than 2 years. Additionally, immediate spica casting with early discharge to home is associated with few complications, no functional limitations, and minimal limb length inequality.