Improved treatment of femoral shaft fractures in children: the Pontoon 90-90 spica cast

In the past 15 to 20 years, little improvement has been made in the standard treatment of femur fractures in children. Children younger than two years of age or weighing less than 30 pounds are normally treated with skin traction or immobilized in a plaster cast or both. Older or heavier children are often treated with skeletal traction, followed by early or late application of spica cast in the neutral position. A method of spica cast treatment that immobilizes the limb in the 90-90 position using a reinforced cast incorporating a distal femoral traction pin--the pontoon spica--allows for early cast application and discharge from the hospital and encourages early motion of the knee joint. A series of 23 femur fractures in 21 patients were treated with this method. This series is compared with a series of 38 fractures treated with conventional methods. The follow-up period ranged from three to 24 months. The pontoon method provided better results in control of alignment than the conventional method, with no greater discrepancy in leg lengths than generally observed after skin traction and hip spica casts. The average hospital cost reduction was 73%, or approximately $13,334. There were no major complications with the pontoon method, which is now a standard treatment for femoral fractures in children.