{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:12:01Z","timestamp":1753891921696,"version":"3.41.2"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>While both short- and long-leg spica casts present viable options after closed reduction (CR) in developmental dysplasia of the hip (DDH), comprehensive comparative studies are needed to guide clinical practices. This multi-center retrospective study aimed to evaluate their effectiveness in treating DDH and identify predictors of treatment failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study analyzed 146 DDH patients (0\u201318 months) treated with closed reduction and spica casts (70 short-leg vs. 76 long-leg) at two tertiary centers (2005\u20132024). Incident-free survival (time from casting to failure: re-dislocation, imaging-confirmed reduction loss, or surgical conversion) was analyzed via Kaplan\u2013Meier\/Log-rank tests. A multivariable Cox model evaluated eight variables: cast type, age (&amp;gt;6 vs. \u22646 months), sex, laterality (bilateral\/unilateral), IHDI grade (IV\/III), birth presentation, delivery mode, and family history, allowing quantification of independent predictors associated with treatment failure risks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The analysis of 146 DDH cases (70 short-leg vs. 76 long-leg casts) revealed significant outcome differences between cast types. Patients receiving long-leg spica casts demonstrated substantially higher 6-month incident-free survival rates (84% vs. 68%, Log-rank <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.05), with multivariable Cox regression confirming long-leg casting as an independent protective factor (HR\u2009=\u20090.45, 95% CI 0.32\u20130.64, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). The analysis identified three significant risk predictors: older age (&amp;gt;6 months) increased failure risk by 89% (HR\u2009=\u20091.89, 95% CI 1.02\u20133.51), bilateral involvement elevated risk by 78% (HR\u2009=\u20091.78, 95% CI 1.25\u20132.54), and IHDI IV dysplasia doubled failure likelihood (HR\u2009=\u20092.15, 95% CI 1.45\u20133.18). Notably, cephalic presentation showed a protective trend (HR\u2009=\u20090.67, 95% CI 0.48\u20130.93), while delivery mode and family history did not reach statistical significance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Long-leg spica casting shows superior biomechanical stability in DDH management post-CR, particularly for high-risk patients. These findings support its preferential use in patients with bilateral involvement, advanced dysplasia, or older age (&amp;gt;6 months).<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1563536","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T06:25:13Z","timestamp":1743488713000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-leg spica casts demonstrate superior outcomes in developmental dysplasia of the hip: a multi-center retrospective analysis of failure risks and protective 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