Peroneal nerve palsy after early cast application for femoral fractures in children

The incidence and contributing factors associated with postcasting peroneal nerve palsy were examined in a series of 110 consecutive pediatric femoral shaft fractures treated with early hip spica cast application. Four patients with peroneal nerve palsy were identified. All four had 90°/90° casts placed and underwent cast wedging for alignment. All palsies resolved with immediate cast removal. Other treatment options for certain femur fractures with significant initial shortening should be considered. We advise pre and postcast neurologic examination and avoidance of forceful distraction. Fracture manipulation, through wedging, should be delayed.