De-Cast the Kids, Says Hopkins Study (Biloine Young @ OTW)
new study from Johns Hopkins Children’s Center challenges the longstanding practice of casting both legs in small children who have hip or thigh fractures. A study of 52 patients, ages two through six, found that the children healed just as well in single-leg casts as did those with both legs in casts and experienced far greater comfort and mobility. The study is published in the June 13 online issue of The Journal of Bone and Joint Surgery.
For a long time doctors thought that casting both legs and hips was the only way to assure proper healing and pelvic immobilization in wiggle-prone young children who seemed to be always in motion. The results of this study have changed all of that.
Senior investigator Paul Sponseller, M.D. M.B.A, director of pediatric orthopedics at Johns Hopkins Children’s Center, said, “The single-leg approach not only appears to be just as effective and safe as double-leg casting in terms of healing, but also it makes the child’s life much easier and requires less complicated daily care.”
Older children who break a hip or thigh are candidates for surgical repair but children younger than six have done better with casting only, according to investigators. The American Academy of Orthopaedic Surgeons agrees and has recently recommended casting as the first line of treatment for children younger than five to avoid general anesthesia and surgical complications.
The cast works by immobilizing the hips and thighs so that bones or tendons can heal properly. Unfortunately, it can also be cumbersome and uncomfortable. Casting often restricts motion and causes skin problems, increased muscle pressure and reduced blood flow to nerves and tissue. The casting also requires more complex daily maintenance by parents and other caregivers.
In the new study, 28 of the 52 children seen at Hopkins were randomly assigned to get double leg casts, while the remainder got single leg casts. The researchers used bi-weekly X-rays to monitor bone healing and questionnaires to gauge parental ease of care and the child’s comfort and physical functioning.
While children in both groups healed equally well without any major complications, those in single-leg casts reported greater comfort and mobility, fit more easily in car seats, got dressed more easily and sat more comfortably in chairs. Also, the parents and caregivers of children in single-leg casts reported taking less time off from work to provide care, having missed, on average, eight fewer days from work.