Can Paediatric Femoral Fracture Hip Spica Application be Done in the Outpatient Setting?

@#children with femur fractures. This study compares the outcomes of spica cast application, in terms of quality of fracture reduction and hospital charges when performed in operating theatre versus outpatient clinics at a local institution. Materials and Methods: A total of 93 paediatric patients, aged between 2 months to 8 years, who underwent spica casting for an isolated femur fracture between January 2008 and March 2019, were identified retrospectively. They were separated into inpatient or outpatient cohort based on the location of spica cast application. Five patients with metaphyseal fractures and four with un-displaced fractures were excluded. There were 13 and 71 patients in the outpatient and inpatient cohort respectively who underwent spica casting for their diaphyseal and displaced femur fractures. Variables between cohorts were compared. Results: There were no significant differences in gender, fracture pattern, and mechanism of injury between cohorts. Spica casting as inpatients delayed the time from assessment to casting (23.55 ± 29.67h vs. 6.75 ± 4.27h, p<0.05), increased average hospital stay (41.2 ± 31.1h vs. 19.2 ± 15.0h, p<0.05) and average hospital charges (US$1857.14 vs US$775.49, p<0.05). Excluding the un-displaced fractures, there were no significant differences in the period of cast immobilisation and median follow-up length. Both cohorts had a similar proportion of unacceptable reduction and revision casting rate. Conclusion: Both cohorts presented similar spica casting outcomes of fracture reduction and follow-up period. With spica cast application in operating theatre reporting higher hospital charges and prolonged hospital stay, the outpatient clinic should always be considered for hip spica application.

Obturator Internus Pyomyositis in A Child: A Case Report

Obturator internus pyomyositis is a rare disease that is more commonly found in tropical countries. Due to its infrequent occurrence, it is a differential of hip pain that has not been sufficiently considered, which often results in delayed diagnosis. We present a case report of a 4 year old boy with pyomyositis of obturator internus as well as externus. He was treated successfully with intravenous antibiotics. A comparison is made with other case reviews to identify symptoms and signs that could help in diagnosing the condition early and accurately so as to initiate intravenous antibiotics, the mainstay treatment in a timely fashion, eventually avoiding surgical drainage of the sequelae when it becomes an abscess.