Journal of Pediatric Orthopaedics - 2026-05-18 - Journal Article
Prefabricated Functional Bracing Versus Spica for Pediatric Femur Fractures Reduces Cost.
Stamatos NJ, Frederickson M, Wise PM, Terle MR, Haus B, Leshikar HB, Whitaker AT
Topics
Key Takeaway
Prefabricated functional bracing reduced mean hospital charges by $22,520 per patient and LOS by 9.8 hours compared to spica casting, with 77% of brace patients requiring no sedation.
Summary Depth
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Summary
This single-center study compared hospital utilization and outcomes in children aged 6 months to 5 years with isolated femoral shaft fractures treated with spica casting (retrospective, 2021–2024) versus prefabricated functional bracing applied in the ED (prospective identification, 2024–2025). PFB reduced LOS (16.4 vs. 26.2 h, P=0.003) and total charges ($56,372 vs. $78,892, P<0.001) with no general anesthesia required in any brace patient. Complication rates were statistically similar (27% vs. 37%, P=0.57), though the study was underpowered to detect meaningful clinical differences.
Key Limitation
The non-concurrent control design with a substantially different payer mix between groups (71% vs. 41% public insurance) limits causal inference about cost and outcome differences despite statistical adjustment.
Original Abstract
BACKGROUND
Hip spica casting under general anesthesia is standard treatment for femoral shaft fractures in children aged 6 months to 5 years. Prefabricated functional braces (PFBs) can be applied in the emergency department without general anesthesia. We compared hospital utilization, charges, reimbursement, and short-term outcomes between treatments.
METHODS
We reviewed children aged 6 months to 5 years with isolated unilateral femoral shaft fractures treated at a single level I trauma center. Spica patients were identified retrospectively (2021 to 2024; n=38), and PFB patients were identified (2024 to 2025; n=22). We compared length of stay (LOS), hospital-based (HB) and professional-based (PB) charges, reimbursement proportion, sedation requirements, and complications. Insurance was categorized as public versus private, and reimbursement was analyzed overall and within insurance strata.
RESULTS
PFB treatment reduced LOS (16.4±8.2 vs. 26.2±15.9 h, P=0.003) and total charges ($56,372±$15,212 vs. $78,892±$14,780, P<0.001), a mean reduction of $22,520 per patient (~$20,000 net after device cost). Public insurance was more common in the spica group (71% vs. 41%, P=0.030). Overall reimbursement proportion was higher for PFB (47.8%±37.4% vs. 26.2%±30.2%, P=0.027); however, within insurance strata, reimbursement did not differ significantly by treatment, suggesting the unadjusted difference was attributable to payer mix. No brace patient required general anesthesia; 77% required no sedation. Total charges did not differ by sedation status within the brace group ($55,594 vs. $55,640). Complication rates were similar (27% vs. 37%, P=0.57).
CONCLUSIONS
In appropriately selected young children with femoral shaft fractures, PFB management avoids general anesthesia, shortens LOS, and substantially reduces charges while maintaining comparable short-term clinical outcomes.
LEVELS OF EVIDENCE
Level III-therapeutic.