Abstract
Today more and more papers are published about the operative treatment of femoral fractures in children and even uncomplicated and isolated fractures are treated by using elastic nails, plates or an external fixator. Advantages are said to be a shorter stay in the hospital, easier handling by parents and nurses, less costs and better control of rotational disorders, and without complications from anaesthesia or an operation. We summarised our results in treating conservatively 50 femoral fractures in 49 children treated between 1992 and 1997.
The mean age was 6.2 years; male/female ratio was 30/19. We included five children with minor polytraumatisation (including one girl with a bilateral femoral fracture) and two children with complicated fractures (grade I). Children younger than three years of age were treated by Bryant-traction (18), and children older than three years were treated by Weber-traction (23). In both groups the callus was palpable after 2 to 3 weeks and a “one-legged” hipspica-plaster-cast was applied. Full weight bearing was permitted. Children needing surgery (major polytraumas, brain damage, etc.) were excluded. Seven cases had a fracture without dislocation and were treated by early casting. One boy was treated by Russell-traction.
An unacceptable dislocation of the fracture still existed in two cases after one week with Weber-traction. Peroperatively, interposition of the soft tissues appeared to be the reason. There were no problems of alignment and rotation, but differences in leg length or problems in consolidation were seen in the group treated with Bryant- traction. In the Weber-traction group, the girl with the bilateral femoral fracture developed a mild endorotation in the left leg, but we saw no further complications.
We think that these results in treating femoral fractures conservatively are satisfying and there is still a place for conservative treatment of femoral fractures in children. In our hospital we try to advance this type of conservative treatment by selecting cases that are appropriate for home traction, which is better for children and their parents and also less expensive for the Health Care System.
The abstracts were prepared by David P. Davlin. Correspondence should be addressed to him at the Orthopedic Clinic Bulovka, Budínova 2, 18081 Prague 8, Czech Republic.
