Use of a single-leg spica cast for femoral fractures in ambulatory children 1 to 5 years of age facilitates care and mobilization of the patient. It may allow a shorter duration of cast treatment than is possible with a traditional one and one-half-leg spica cast, particularly in patients 1 to 3 years of age. The single-leg spica is indicated for children who are small enough to be lifted safely in the cast and who have an isolated, closed, low-energy femoral shaft fracture. The procedure consists of the following steps:
Following cast application, distal neurovascular status is assessed. The caretakers are trained in cast care and safe patient transport. The fit of the car seat is checked prior to discharge from the emergency room or hospital. Follow-up radiographs with the patient in the cast should be obtained 10 days after cast application. Angulation of ≤15° and shortening of <2 cm can generally be accepted in patients with a midshaft fracture. Angulation of >15° can often be managed with wedging of the cast in the clinic. Excessive shortening may require reapplication of the cast or a change to another stabilization method. Single-leg spica treatment of femoral fractures in children ≤5 years of age has provided reliable outcomes with few complications. Usually, the cast can be removed 4 to 6 weeks following application.