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Single-leg versus double-leg hip spica casts in the management of paediatric femoral shaft fractures? A systematic review and meta-analysis.
Curtis, Alexander; Scattergood, Sean; Beaumont, Oliver; Jenkins, Miss Lydia; Abas, Sameera; Hassan, Abdul; Morriss, Felix.
Affiliation
  • Curtis A; Faculty of Health Sciences, University of Bristol, Bristol, UK.
  • Scattergood S; Southmead Hospital, Bristol, UK.
  • Beaumont O; Faculty of Health Sciences, University of Bristol, Bristol, UK.
  • Jenkins ML; Southmead Hospital, Bristol, UK.
  • Abas S; Faculty of Health Sciences, University of Bristol, Bristol, UK.
  • Hassan A; Bristol Children's Hospital, Bristol, UK.
  • Morriss F; Faculty of Health Sciences, University of Bristol, Bristol, UK.
J Clin Orthop Trauma ; 53: 102438, 2024 Jun.
Article in En | MEDLINE | ID: mdl-38975295
ABSTRACT

Background:

Paediatric femoral shaft fractures can be managed with single- or double-leg hip spica casting between ages six-months and six-years. The aim of this review was to determine if single-leg hip spicas reduce the impact on family life without compromising fracture stability.

Methods:

The study was registered on PROSPERO (CRD42023454309). MEDLINE, Embase, Web of Science, Cochrane Library, and clinical trial registers were searched to May 2023 for level I-III evidence. Primary outcomes were impact on family life and fracture stability. Where appropriate, Meta-analysis was completed using RevMan v5.4. Risk of bias was assessed using RoB 2.0 (RCTs) and ROBINS-I (non-RCTs). Certainty of evidence was measured with GRADE.

Results:

From 234 identified papers, four met the inclusion criteria (two RCTs; two non-RCTs). A total of 339 children were included (single-leg spica 176; double-leg spica 163). Three studies were 'high risk' and one study 'moderate risk' of bias. Impact on family life parameters were too heterogenous for pooled meta-analysis. Non-pooled data identified significantly more missed work days in the double-leg spica group and the 'Impact on Family' Scale significantly favoured single-leg spicas. For fracture stability, meta-analysis identified that (i) mal-union rates were significantly lower in single-leg spica OR 0.08 (95 % CI 0.01 to 0.69; p = 0.02); (ii) MUA in theatre was not significantly different OR 0.97 (95 % CI 0.19 to 4.86; p = 0.97); and (iii) wedge adjustment was not significantly different OR 3.46 (95 % CI 0.48 to 24.92; p = 0.22). Certainty of evidence was assessed as 'very low'.

Conclusion:

Single-leg hip spicas may be associated with reduced impact on family life without compromising fracture stability compared with double-leg hip spicas. However, the evidence is weak. Therefore, a propensity score matched observational study is required to understand if subgroups of patients (age, fracture pattern, mechanism of injury) would benefit from a single- or double-leg hip spica.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: J Clin Orthop Trauma Year: 2024 Document type: Article Country of publication: India

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: J Clin Orthop Trauma Year: 2024 Document type: Article Country of publication: India