Comparison of the Walking Hip Spica Cast and the Conventional Spica Cast in Femoral Shaft Fractures in Children Under Five Years of Age

Background Femoral shaft fractures are common in children under five, and conservative management with hip spica casting remains the standard of care. Objective The main objective of this study is to compare clinical, radiological, functional, and caregiver-related outcomes between walking hip spica and conventional hip spica casts in children under five years of age with femoral shaft fractures. Methodology This prospective observational study was conducted at the Department of Orthopaedic Surgery, Mardan Medical Complex (MMC), Mardan, Pakistan, from January 2023 to December 2024. A total of 94 children aged 1-5 years with closed, isolated femoral shaft fractures were enrolled. Patients were divided into two groups: 47 children (50%) received a walking hip spica cast (Group A), and 47 children (50%) received a conventional hip spica cast (Group B). Follow-up evaluations were performed at 2, 4, 6, and 12 weeks to assess radiological union, complications, functional milestones, and parental satisfaction. Data were analyzed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, NY, USA), with significance set at p < 0.05. Results Radiological union at 12 weeks was achieved in all 47 patients (100%) in Group A, and 46 patients (97.87%) in Group B. Mean time to union was significantly shorter in Group A (6.28 ± 1.04 weeks) versus Group B (6.74 ± 1.21 weeks, p = 0.021). Complications occurred in five patients (10.64%) in Group A and 12 patients (25.53%) in Group B (p = 0.048). Functional recovery at six weeks (walking unassisted) was observed in 36 patients (76.60%) in Group A and 30 patients (63.83%) in Group B. High parental satisfaction was reported by 42 parents (89.36%) in Group A versus 28 parents (59.57%) in Group B (p = 0.001). Conclusion Walking hip spica casts demonstrated better clinical, functional, and caregiver satisfaction outcomes than conventional spica casts in young children with femoral shaft fractures.