Femoral shaft fractures in children treated with early spica cast

We retrospectively reviewed 51 patients aged 3-11 years with femoral shaft fractures selected for treatment with early spica cast immobilization. Shortening >20 mm was the most common complication, occurring in 22 (43%) of the 51 patients. Factors associated with unacceptable shortening were shortening at the time of spica cast application >10 mm, shortening >20 mm at initial examination, and increasing age. Achieving <1 cm shortening at the time of cast application and close follow-up during the first 2 weeks after cast application are advised in order to achieve an acceptable final outcome.