Manual traction reduction without anesthesia and immediate
immobilization in a spica cast were used to treat eighty-five children
ranging in age from birth to ten years old who had closed femoral-shaft
fractures and no associated injuries. Up to two centimeters of overriding,
30 degrees of anterior angulation, and 15 degrees of medial angulation were
accepted. Any angulation in excess of these amounts, or lateral or
posterior angulation, was corrected by wedging the cast at the fracture
site. Further telescoping of the fracture fragments in the case was
attributed to the child pressing the foot against the bottom of the cast
and was prevented by removing the sole of the cast. Of the seventy-five
children examined two to eighteen years after fracture, none had any
residual skeletal deformity or joint stiffness. The length discrepancies of
the fractured limbs ranged from 1.7 centimeters of shortening to 0.9
centimeter of overgrowth.