Question: In children with femoral fractures, how does early application of hip spica compare with external fixation with regard to malunion rates, physical function, behavioral disturbances, and patient satisfaction?
Design: Randomized (allocation concealed), blinded (outcome assessor), controlled trial with 2-year follow-up.
Setting: 4 pediatric hospitals in Toronto, Ontario, Canada; Melbourne, Victoria, Australia; Los Angeles, California, United States; and Auckland, New Zealand.
Patients: 108 children who were 4 to 10 years of age (mean age, 6 y; 70% boys) and had femoral fractures. Exclusion criteria were hip fracture, distal femoral physeal fracture, head injury (Glasgow Coma Scale score <11), pathological fracture, or open fracture. 94% of children were followed.
Intervention: Children were allocated to early hip spica (n = 60) or external fixation (n = 48). Children in the hip-spica group received general …
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