Fractures of shaft and neck of femur: Report of 119 cases

Abstract

One hundred and nineteen children with fractures of the femur have been treated on the Children's Surgical Service of Bellevue Hospital from January 1, 1930 to December 31, 1935; 30 of these by the Modified Bryant's Overhead Suspension, 15 by reduction on a Hawley Table and the application of a continuous adhesive skin traction and a plaster spica cast and 72 by Russell's Method of traction and suspension. The procedures which gave uniformly good results in the 268 cases of fractures of the femur reported by Burdick and Siris in 1923 have been followed in this series with the exception that Russell's method of suspension has been added and has been found so satisfactory that it has gradually supplanted the cast and traction methods. In the case of infants and children under four years of age, the Modified Bryant's Overhead Pulley Suspension with sufficient weight to keep the buttocks uninterruptedly off the mattress, is recommended. The Russell Method of traction has been routinely adopted on the service for children older than four years of age for the following reasons; it is simple in its application and management; it is effectual in alining the fragments and it entails few nursing problems. The method permits early active motion and results in an exuberant amount of callus and complete restoration of function. The incidence of satisfactory apposition of the fragments was higher with Russell Traction than with other methods that we have used. This in part can be attributed to the obligatory application of the Thomas splint to the injured limb by the ambulance surgeon before transporting the patient to the hospital from the site of accident. There was no residual shortening in 109 of the 115 cases of fractures of the shaft of the femur. Three children in this group of 119 cases could not be traced. The others were followed from three months to six years. There was only one case in this series of separation of the upper epiphysis and none of the lower. One case of separation of the lower epiphysis occurred in our previous group. The separation of the upper epiphysis was effectually reduced by Russell Traction with the limb in abduction and internal rotation. Fractures of the neck of the femur in children can be effectively reduced and treated with comfort in Modified Russell Traction the limb being held in abduction and internal rotation. In this series of fractures of the shaft and neck of the femur there was no case of non-union. When the anatomical approximation of the fragments of bone was absent the normal continuity and contour of the shaft of the femur became re-established within two to three years. Open operation was not indicated in any case of this series and is rarely justified in children unless some mechanical interposition prevents union after prolonged immobilization.