Prefabricated Functional Bracing Versus Spica for Pediatric Femur Fractures Reduces Cost

BACKGROUND: Hip spica casting under general anesthesia is standard treatment for femoral shaft fractures in children aged 6 months to 5 years. Prefabricated functional braces (PFBs) can be applied in the emergency department without general anesthesia. We compared hospital utilization, charges, reimbursement, and short-term outcomes between treatments. METHODS: We reviewed children aged 6 months to 5 years with isolated unilateral femoral shaft fractures treated at a single level I trauma center. Spica patients were identified retrospectively (2021 to 2024; n=38), and PFB patients were identified (2024 to 2025; n=22). We compared length of stay (LOS), hospital-based (HB) and professional-based (PB) charges, reimbursement proportion, sedation requirements, and complications. Insurance was categorized as public versus private, and reimbursement was analyzed overall and within insurance strata. RESULTS: PFB treatment reduced LOS (16.4±8.2 vs. 26.2±15.9 h, P=0.003) and total charges ($56,372±$15,212 vs. $78,892±$14,780, P<0.001), a mean reduction of $22,520 per patient (~$20,000 net after device cost). Public insurance was more common in the spica group (71% vs. 41%, P=0.030). Overall reimbursement proportion was higher for PFB (47.8%±37.4% vs. 26.2%±30.2%, P=0.027); however, within insurance strata, reimbursement did not differ significantly by treatment, suggesting the unadjusted difference was attributable to payer mix. No brace patient required general anesthesia; 77% required no sedation. Total charges did not differ by sedation status within the brace group ($55,594 vs. $55,640). Complication rates were similar (27% vs. 37%, P=0.57). CONCLUSIONS: In appropriately selected young children with femoral shaft fractures, PFB management avoids general anesthesia, shortens LOS, and substantially reduces charges while maintaining comparable short-term clinical outcomes. LEVELS OF EVIDENCE: Level III-therapeutic.