O2137: Dynamic Femur Fracture Brace vs Hip Spica Cast for Pediatric Femoral Shaft Fractures: A Retrospective Comparative Cohort Study

Background: Femoral shaft fractures constitute 1.6% of pediatric fractures and are a leading cause of pediatric orthopedic hospitalization. The prefabricated DF2 functional brace offers an alternative to traditional spica casting, which is effective but has limitations. This study compares outcomes and complications between the DF2 brace and spica casting in the management of pediatric femoral shaft fractures.

Methods: A retrospective comparative cohort study analyzed 40 patients aged 1-5 years with diaphyseal femur fractures treated between September 2021- August 2024 in a single level 1 trauma center. Twenty patients treated with the DF2 brace were compared with 20 spica cast patients with similar ages, weights, and fracture patterns. Primary outcomes included fracture union, time to weight-bearing, and radiographic alignment. Secondary outcomes encompassed hospital admission rates, length of stay, and complications.

Results: Demographics were similar between groups (mean age 2.2 years, 80.0% male). Hospital admission rates were significantly lower in the DF2 group (35.0% vs 75.0%, p=0.011) with shorter median length of stay (0 vs 1 day, p=0.0079). 90.0% of spica cast patients underwent general anesthesia in an operating room compared to none in the DF2 group. All fractures achieved radiographic union by 6 weeks, with similar time to brace/cast removal and weight-bearing (DF2: 41 days, Spica: 39 days, p=0.19). Statistically significant differences in final sagittal plane angulation were found in DF2 group (DF2: 7° vs. Spica: 0°, p=0.038), but no malunions occurred. The DF2 group had more emergency department returns (3 vs 1), while the spica group had two cases of skin breakdown. In 2024 our preferred treatment method for isolated pediatric femoral shaft fractures changed from spica casting to functional bracing.

Conclusion: The DF2 brace demonstrated similar clinical outcomes compared to spica casting while significantly reducing hospital admissions, length of stay, and need for general anesthesia. Our study replicates previously presented work that the DF2 brace represents an attractive alternative for managing pediatric femoral shaft fractures, optimizing healthcare resource utilization without compromising treatment efficacy.