Abstract
Objectives:To determine the clinical and radiological outcome of proximal femur shaft fractures in school going children treated with locking compression plates (LCP).Methods:This descriptive study was conducted in Orthopaedic Division Lady Ready Reading Hospital Peshawar from 25th June 2018 to 25th September 2020. Children of either gender and age 6 to 12 years old with subtrochanteric and proximal one third femur factures fulfilling the inclusion criteria were enrolled in this study. Open reduction and internal fixation with 4.5 mm narrow locking compression plates (LCP) were done in all. Post operative clinical outcome was evaluated by using Flynn scoring system and graded as excellent, satisfactory and poo results. Radiological assessment of fracture union was done through anteroposterior (AP) and lateral X-ray radiographs.Results:A total of 60 children with mean age 9.01±1.61 SD (range 6 to 12 years) were included in our study. Oblique fractures were present in 23(38.3%) children, spiral in 20(33.3%), transverse in 11(18.3%) and comminuted in 6 (10%) children. The radiological union time was 13.3±1.2 weeks (range 9.4 to 18 weeks). Majority (88.3%, n=53) of children had excellent clinical outcome according to Flynn’s scoring system while satisfactory outcome was noted in 7(11.6%) children. No cases of delayed union, mal union, nonunion and implant failure was reported.Conclusion:The results of our study indicated that proximal femoral shaft fractures in school going children treated with locking compression plates had excellent clinical and radiological outcome. We therefore recommend locking compression plate as the implant of choice to fix proximal femoral shaft fractures in school going children.
Highlights
Subtrochanteric femur fractures in children accounts for approximately 4 to 10% of all femur fractures.[1]
These fractures are treated with locking compression plates (LCP) to avoid excessive per operative radiation hazards and to minimize the post operative complications of flexible intramedullary nails.[2]
Locking compression plates are preferred over conventional stainless steel dynamic compression plates (DCP) to treat these fractures because they are usually close to the proximal metaphysis and physis allowing a very limited space for internal fixation and with very low screw purchase.[8,9]
Summary
Subtrochanteric femur fractures in children accounts for approximately 4 to 10% of all femur fractures.[1]. Pak J Med Sci September - October 2021 Vol 37 No 5 www.pjms.org.pk 1353 unstable subtrochanteric and proximal fractures in older and obese children when treated with elastic intramedullary nails results in high complication rates like delayed union, malunion, limb length discrepancy and refracture after implant removal.[5]. Locking compression plating is a safe and effective alternative to elastic intramedullary nailing for proximal femoral shaft fractures in school going children with excellent post operative clinical and radiological outcome.[11]
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