Eighty-four pediatric patients (aged 2 to 6 years) with unilateral closed femoral fractures were randomized to receive either a single-limb spica cast (n=42) or a one-and-a-half spica cast (n=42). The primary outcome was postprocedural functional and radiologic outcomes. Secondary outcomes included parental ease of hygiene maintenance, child mobility while in the cast, and incidence of skin complications. Outcomes were assessed up to at least 10 months postoperatively. Overall, the results revealed no significant differences in time to bone union or overall complication rates between the two groups. However, parental satisfaction was significantly higher in the single-limb spica group, particularly regarding hygiene maintenance and child mobility. Additionally, the one-and-a-half spica cast group had a significantly higher occurrence of skin pressure ulcers. These findings suggest that single-limb spica casting may be the preferred method due to improved parental satisfaction and fewer skin complications without compromising fracture healing.