Results of femoral shaft fractures in childhood in relation to different treatment modalities

Abstract

The clinical and radiological results of femoral shaft fractures in childhood were evaluated and compared in relation to different treatment modalities. One hundred and one children (mean age 5+/-0,4 years) were treated between 1990 to 1999. 38% of the patients were treated conservatively (mean age 2,2+/-0,5 years), 32% of the patients (mean age 6+/-0,5 years) were treated by external fixation, 17% were treated with elastic stable intramedullary nailing (ESIN, mean age 5,6+/-0,8 years) and 12% underwent other internal fixation procedures. The duration of hospital stay was significantly longer in the conservative treatment group (18+/-1,6 days) than in the external fixator (12+/-1,2 days) as well as in the ESIN group (8+/-0,9 days). Radiological controls revealed a significantly better reduction of the fracture by operative procedures (external fixator,ESIN) as compared to conservative management. Complications, i.e. secondary dislocation or infection, occurred in 25% of patients in the external fixator group,6% of the ESIN patients, and in 10% of the conservatively treated patients. Late complications,i.e.weight bearing dependent pain or hypertrophic scarring,were developed in both the conservative treatment group (4%) and in the external fixator group (19%); however,no late complications were seen in the ESIN group. While each method examined is known to be suitable for treatment of femoral shaft fractures in childhood,each has defined indications. Also there is a limited possibility of fracture reduction in conservative treatment this method is indicated in younger children (<4 years) where spontaneous bone remodelling is likely. For older children the ESIN method showed a low rate of complications and demonstrates the best long term results. When ESIN is not possible because of local soft tissue damage,additional injuries,or in complex fractures, the external fixator proved to be an alternative treatment for femoral shaft fractures.