APEA Management Orthopedics Practice Test 2026 – Complete Exam Prep

Spica casting is most appropriate when the fracture is stable and can be kept in proper alignment with immobilization alone. In children, after closed reduction, a hip-spica cast provides rigid immobilization of the femur from trunk to foot, allowing healing while avoiding surgery. The bones in kids remodel well, so maintaining alignment with a cast often suffices for diaphyseal femur fractures that are not displaced or destabilized. In contrast, unstable fractures tend to redisplace despite casting and usually need surgical stabilization; open fractures require immediate soft-tissue management and cannot be adequately treated with a cast; and fractures in elderly patients fall outside pediatric practice.