Abstract
BACKGROUND: This study aimed to compare the clinical, radiological, and cost-related outcomes of early spica casting performed without anesthesia in the emergency department and spica casting performed under general anesthesia in the operating room for the treatment of femoral shaft fractures in children under five years of age. METHODS: One hundred eleven patients who underwent closed reduction and spica casting for femoral shaft fractures between 2020 and 2024 were retrospectively reviewed. Patients were divided into two groups according to where the spica cast was applied: Emergency Department Group (ED group, n=71) and Operating Room Group (OR group, n=40). The groups were compared in terms of age, sex, fracture type, radiological alignment, and treatment costs. RESULTS: No statistically significant differences were found between the two groups regarding age, sex, fracture pattern, or final radiological alignment. However, treatment costs were significantly lower in the emergency department group. Complication rates were also similar between the groups. CONCLUSION: Early spica casting performed in the emergency department without general anesthesia provides radiological out-comes comparable to those achieved in the operating room while offering a significant cost advantage. With appropriate patient selec-tion, this method represents a safe and effective treatment option.