Treatment of Femur Fractures in Preschool Children with Double Pin Technique: Immediate Incorporated Hip Spica Casting by Two K-Wires.

Abstract

The immediate hip spica casting is a popular treatment method for femoral fractures in the pediatric age group. Femoral shortening is the unacceptable result for the treatment. In this technique, we tried to describe the immediate spica casting technique pinning with double K-wire in preschool children and evaluate the results with this method. Sixteen patients (ten boys and six girls) are treated with this technique. Patients were treated under general anesthesia in the operating room. K-wire was introduced in the supracondylar area of the femur passing from the lateral to the medial side through both cortexes, and removed from the skin in the medial section. A second K-wire was introduced through the lateral side of the proximal fragment. While an assistant was applying traction to the pin to maintain the reduction, the lower extremity was put in a spica cast on the fractured side, while the knee joint on the other side was excluded from the spica casting process. The angulation after hip spica cast applied was 9.1° (range 7°-12°) on the frontal plane and 8.9° (range 5°-17°) on the sagittal plane. After spica cast removal, it was 8.5° (range 5°-13°) on the frontal plane and 9° (range 5°-17°) on the sagittal plane. No significant difference was found. The final mean leg length discrepancy was 4.8mm (range 0-10mm) at the time of cast removal. This technique may be effective for femoral diaphyseal fractures in preschool children to combine the spirits of external fixation with hip spica casting in one construct in order to correct angular deformities and length discrepancies.