Table 2.

Comparison of dynamic skeletal traction spica casting (DSTSC) with various traction and spica casting techniques for treatment of pediatric femoral shaft fractures

Type of traction treatment	Initial management/in-hospital stay	Treatment course
Traditional traction	Skin traction (txn) with pulleys and weights	Six to eight weeks or until complete healing and return to function
Other traditional traction	Preliminary skin txn	Two to three weeks (skin or skeletal txn below tibial tubercle, trans-femoral condyles) followed by spica cast, discharged as outpatient until fracture heals, cast removed
Static traction spica 90/90 cast	Hip and knee flexed at (90°) with skeletal txn applied through the femoral condyles in this position	Two to three weeks followed by spica cast in this position incorporating the pin in the cast, discharged as out patient until fracture heals
Other static traction casts	Preliminary skin txn	One to two days then skeletal txn pins at the femoral condyles or below tibial tubercle incorporated into the spica casts, discharged when fracture heals, pins removed earlier as outpatient. Cast can also be applied incorporating tape to the skin to apply txn (dynamic) but this is typically not well maintained
Dynamic skeletal traction spica cast (DSTSC)	Preliminary temporary skin txn	One to two days skeletal txn pin inserted at distal tibia as feasible, incorporated into spica cast with the DSTSC txn apparatus, discharged in four in-hospital days as outpatient, followed until fracture heals. DSTSC is the only continuously controlled txn cast in contrast to static casts and can be used with varying cast lengths