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

Abstract

Background: Femoral shaft fractures constitute 1.6% of pediatric fractures and are a leading cause of pediatric orthopaedic hospitalization. The prefabricated DF2 functional brace offers an alternative to traditional spica casting, which is effective but has limitations. This study compares short-term 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 = .011) with shorter median length of stay (6.1 vs 22.9 h, P = .0004). 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 = .19). Statistically significant differences in final sagittal plane angulation were found in the DF2 group (DF2: 7° vs. Spica: 0°, P = .038), but no malunions occurred. The DF2 group had more emergency department returns (3 patients vs 1 patient), 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 short-term 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. Key Concepts: (1) The DF2 brace's modular design with adjustable compression and hip hinge system enables straightforward application in the emergency department under conscious sedation, facilitating femur fracture stabilization without requiring general anesthesia or operating room resources. (2) The DF2 brace demonstrated similar short-term clinical outcomes to traditional spica casting for pediatric femoral shaft fractures while significantly reducing hospital admissions, length of stay, and need for general anesthesia. (3) All patients in both treatment groups achieved radiographic bone union by 6 weeks, with comparable time to weight-bearing and no observed malunions. (4) Our institution's treatment approach shifted dramatically from 100% spica casting in 2021–2022 to 90.5% DF2 bracing by mid-2024, reflecting rapid adoption based on favorable clinical outcomes and healthcare resource utilization. Level of Evidence: Level III retrospective case-control study

Keywords

• Pediatric fracture
• Femoral shaft fracture
• Spica cast
• Functional brace