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