Journal of Pediatric Orthopaedics - 2026-06-22 - Journal Article
Short Leg Cast Versus Long Leg Cast Immobilization for Pediatric Tibia Fractures: A Systematic Review and Meta-Analysis.
Sato A, Khair YJ, Pashou A, Nasr J, Bello AYB, Bulut HI, Abdelrahman RM, Burns JWF, Nakanishi H, Than CA, Suresh S, Lee RJ
Topics
Key Takeaway
Short leg casting achieves equivalent coronal and sagittal alignment to long leg casting in pediatric tibial fractures while reducing time to weight-bearing by 2.29 weeks and time to union by 1.21 weeks.
Summary Depth
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Summary
This PRISMA-registered systematic review and meta-analysis compared short leg casting (n=163) versus long leg casting (n=250) for pediatric tibial shaft and distal physeal fractures across 6 studies identified from 1,236 screened. No significant differences were found in coronal angulation (MD=0.12°), sagittal angulation (MD=0.18°), cast duration (MD=-0.74 wk), or complication rates (OR=0.76) between groups. SLC was associated with significantly shorter time to weight-bearing (MD=-2.29 wk) and faster union (MD=-1.21 wk), with findings consistent across tibial shaft and Salter-Harris distal tibial fracture subgroups.
Key Limitation
All 6 included studies are retrospective, introducing selection bias in which fracture patterns received SLC versus LLC and precluding conclusions about optimal indications.
Original Abstract
BACKGROUND
Pediatric tibial fractures are common long-bone injuries, yet uncertainty remains in the optimal immobilization strategy. The comparative effectiveness and safety of short leg versus long leg casts in achieving stable healing and functional recovery have not been clearly established.
METHODS
A literature search was conducted across Medline, CINAHL, Embase, and Cochrane Library, from inception to August 2025, following PRISMA guidelines and registered with the International Prospective Register of Systematic Reviews (PROSPERO). Statistical analyses were performed using a random-effects model.
RESULTS
The initial search yielded 1236 studies; 6 studies with 413 pediatric patients met the inclusion criteria. A total of 163 underwent short leg casting (SLC) and 250 long leg casting (LLC). No differences were observed between SLC and LLC for coronal angulation (MD=0.12 degrees, 95% CI=-0.89 to 1.12, I2=58%) or sagittal angulation (MD=0.18 degrees, 95% CI=-0.71 to 1.07, I2=56%). Subgroup analyses showed no differences for tibial shaft fractures or Salter-Harris distal tibial fractures. Cast duration was similar between groups (MD=-0.74 wk, 95% CI=-1.49 to 0.01, I2=92%). Overall complication rates did not differ (OR=0.76, 95% CI=0.25 to 2.34, I2=0%), with no differences in Salter-Harris subgroup analysis (OR=0.67, 95% CI=0.05 to 9.91; I2=54%). SLC was associated with shorter time to weight-bearing (MD=-2.29, 95% CI=-4.49 to -0.08, I2=68%) and faster time to union (MD=-1.21, 95% CI=-2.16 to -0.25, I2=30%).
CONCLUSION
SLCs may be considered as an alternative to LLCs in pediatric tibial shaft and distal tibial physeal fractures based on currently available retrospective comparative evidence. However, the evidence is limited by the retrospective design, clinical heterogeneity, and risk of confounding. Further prospective comparative studies are needed to define optimal indications for SLC use in this population.
LEVEL OF EVIDENCE
Level III, systematic review and meta-analysis of retrospective comparative studies.