A retrospective cohort study comparing outcomes of spica casting in pediatric femoral shaft fractures by orthopedic surgeons fellowship trained in pediatrics vs. those not fellowship trained in pediatrics.

Background: Femoral shaft fractures are common among the pediatric population and are commonly treated with spica casting depending on the patients' age. Both pediatric fellowship-trained and non-pediatric-trained orthopedic surgeons may be expected to treat these injuries while taking call. The purpose of this study is to determine differences in outcomes between casting performed by pediatric-trained orthopedic surgeons and non-pediatric-trained orthopedic surgeons. Materials and methods: A retrospective cohort study of 276 patients aged 0-5 years treated with a hip spica cast for isolated closed femoral shaft fractures was performed. The patients were subdivided based on if the treating orthopedic surgeon completed a pediatric orthopedic surgery fellowship or not. Clinical records and radiographs were reviewed. Primary outcomes included procedure length, malunion rate, and need for revision procedure. Secondary outcomes included time to weight-bearing, time in cast, and length of hospital stay, and complications. Results: There were 62 patients treated by non-pediatric-trained orthopedic surgeons and 214 by pediatric-trained surgeons. All casts were placed in the operating room under general anesthesia. Average operating room time was 37 minutes with non-pediatric-trained surgeons and 32.4 minutes by pediatric-trained surgeons (P = 0.01). The malunion rate was 39% with non-pediatric-trained surgeons and 17.5% with pediatric-trained surgeons (P = 0.0013). There was no significant difference in the length of hospital stay, cast complications, need for cast wedging, or time to weight-bearing. The study was underpowered to detect differences in revision rates. Conclusion: Non-pediatric-trained surgeons were found to have a higher malunion rate and longer operative time. Despite this, spica casting remains a reliable option for both pediatric-trained and non-pediatric-trained orthopedic surgeons. Further study may be needed to assess the clinical significance of the higher malunion rate.