Botchu R, Gopalakrishnan N, Inaparthy P, Ellis S, Ravikumar KJ

Department of Orthopaedics, Maidstone Hospital, Maidstone, ME16 9QQ, UK.

Address for Correspondence
Rajesh Botchu
MRCSI, MRCSEd, MS(Ortho), Department of Orthopaedics
Maidstone Hospital, Maidstone, ME16 9QQ, UK.
Phone: 00447967505057
Fax: 00441622224335
Email: drbrajesh@yahoo.com

Plaster cast is a standard means of management of fractures. The various complications associated with plaster cast (plaster of paris or fiber glass cast) include macerations, ulcerations, infections, rashes, itching, burns, Compartment syndrome and allergic contact dermatitis. We report a 14 month old child with Oseteogenesis imperfecta, who sustained a subtrochanteric fracture of femur following an above knee plaster cast which she had for a fracture of distal tibia. We feel that parents of children in plaster cast should be explained about this potential complication.
Keywords: Fracture, femur, cast

J.Orthopaedics 2006;3(4)e12

Introduction:

Plaster casts are one of the gold standards for non operative treatment of fractures. It is associated with complications which include cutaneous ulcerations, rashes, macerations itching, burns, odour, contact dermatitis and compartment syndrome.1,2,3,4 We report a 14 month old child with Osteogenesis imperfecta, who sustained a subtrochanteric fracture of femur following an above knee plaster cast which she had for a fracture of distal tibia.

14 month female, with ostegenesis imperfecta, sustained an undisplaced, oblique fracture of distal tibia following a fall. (Figure 1) She was managed in an above knee fiber glass cast for the same. (Figure 2)  3 weeks later, while she was still in above knee cast, she had a fall and had a displaced, oblique, subtrochanteric fracture of femur above of the plaster cast.(Figure 3) She was managed with Gallows traction for 4 weeks. The fracture united without any complications at 4 weeks.  

Discussion :

Wessel and colleagues in their series of 196 pediatric tibial fractures concluded that conservative management with a cast is the acceptable mode of treatment for such fractures.5 Schmittenbercher and co workers reported good results with conservative management of such fractures.6 In Shannak’s series of 117 tibial fractures in children who were managed with an above knee plaster cast, all the fractures united in an average period of 7 weeks.7 Gallows traction has been the main stay of management of femoral fractures in children.8,9

In our case fracture of distal tibia was managed with an above knee plaster cast. Unfortunately she had a fall with the plaster in situ and due to concentration of stress at the proximal end of the plaster she sustained a subtrochanteric fracture. This was managed successfully with Gallows traction and a hip spica. We feel that in vulnerable patients like Osteogenesis imperfecta this should be taken into consideration and parents should take precautions during lifting their children

Conclusion :

Proximal end of the plaster may act as a stress riser, resulting in a fracture in patients with osteogenesis imperfecta.

Reference :

1. Beidler JG. Skin complications following cast applications: report of a case. Arch Dermatol. 1968; 98:159-161.

2. Kaplan SS. Burns following application of plaster splint dressings: a report of two cases. J Bone Joint Surg Am. 1981; 63:670-672.

3. Killian JT, Wilkinson L, Logan WS, Perry H. Contact dermatitis to resin-containing casts. Clin Orthop. 1973; 90:150-152.

4. Wolff CR, James P. The prevention of skin excoriation under children's hip spica casts using the Gore Tex pantaloon. J Pediatr Orthop. 1995; 15:386-388.

5. Wessel L, Seyfriedt CS, Hock S, Waag KL. Pediatric tibial fractures: is conservative therapy still currently appropriate? Unfallchirurg. 1997 Jan; 100(1):8-12.

6. Schmittenbecher PP, Dietz HG, Germann C. Late results following tibial fractures in childhood. Unfallchirurg. 1989 Feb;92(2):79-84.

7. Shannak AO. Tibial fractures in children: follow-up study. J Pediatr Orthop. 1988 May-Jun; 8(3):306-10.

8. Axton JH, Bhagat BB, Rittey DA, Davies JC, Dube A. Domiciliary management of simple femoral fractures in children. S Afr Med J. 1977 Jul 2;52(1):27-9.

9. Holmes SJ, Sedgwick DM, Scobie WG. Domiciliary gallows traction for femoral shaft fractures in young children. Feasibility, safety and advantages. J Bone Joint Surg Br. 1983 May;65(3):288-90

This is a peer reviewed paper 

Please cite as : Botchu R: Fracture of femur due to plaster cast in a child

J.Orthopaedics 2006;3(4)e12

URL: http://www.jortho.org/2006/3/4/e12

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