Treatment of the old disptaced femoral shaft fracture in children

Abstract

Objective To investigate the operative treatment of the old displaced femoral shaft fracture in children by open reduction and fixation with plate and screws.Methods The clinical data of 15 patients(male 9 cases,female 6 cases;age from 7 to 12 years with a mean of 10.5 years)with old displaced femoral shaft fracture were retrospectively analyzed.All of them were treated with open reduction and fixation by plate and screws during 2002.5-2006.12.The causes of fractures included car accident in 13 cases and falling down in 2 cases.Two cases were complicated with the pelvic fracture,6 cases with brain trauma,1 case with the skin and soft tissue avulsion at the same side of lower extremity,2 cases with the spleen and the liver rupture.The shorting displacement of legs ranged from 4 to 7 cln with an average of 5.2 on%The angulation of displacement ranged from 30°to 45°with an average of 38°.The time between injury and operation was 4.5 months.Five patients walked with the aid of walking stick in a dropping gait,the others stayed in bed with partial weight loading.The inequality of their two legs ranged from 3 to 8 cm with a mean of 4.9 cm.The motion range of the knee was nearly normal All the patients were treated under epidural anesthesia or general anesthesia.During the operation,the bone callus were resected thoroughly and the anatomic reduction acquired gradually by apex-touching and bending techniques to relax the tension of muscle,nerve and vascular.Blood supplies to the end of the extremity were monitored to reflect the function of the muscle,nerve and vascular.Early physical exercise was applied for all patients.The bome union time,fracture reduction and the complication of vascular and nerve were reeorded and analyzed.Results All the patients were followed up from 1 to 3 years.The x-ray photography was gained at 3,6,12,20 monthsafter operation.And the bony union was obtained in all patients.The fracture was reduced anatomically without any complications of nerve and vascular injury.All the patients walked in a normal gait with full weight bearing.The shorting of the leg ranged from 1 to 2 cm with an average of 1.2 cm.The range of the knee motion was normal Conclusions Open reduction and fixation with plate can be served as an efficient method to treat the displaced femoral shaft fracture in children. Key words: Femoral f ractures; Fracture fixation, internal