Spica Casting Results in More Unplanned Reoperations than Elastic Intramedullary Nailing: A National Analysis of Femur Fractures in the Preschool Population.

In this large, nationally representative cohort, spica casting resulted in higher odds of requiring an unplanned revision surgery than ESIN, when nail removal was not included as an unplanned procedure. Spica casting in 5- and 6-year-olds yielded higher odds of revision surgery. Regardless of whether spica casting or ESIN is chosen as the initial treatment, 2% of patients will subsequently undergo ESIN or open reduction and internal fixation as a revision procedure.