Abstract
The aim of the study was to compared the various treatments of femoral diaphyseal fractures in children. The endpoints being length of hospital stay, clinical and functional outcome. The prospective part of the study started with the appointment of a dedicated children’s orthopaedic surgeon in 1999. Prior to this in patient traction was the main treatment. Now early hip spicas for the under 5 year old, Nancy nails for the over fives and external fixation for polytrauma are the treatments of choice.
Anyone under the age of fifteen sustaining a traumatic femoral diaphyseal fracture was included in the study. In both groups’ details of the injury, demographic details, other injuries sustained, treatment performed and length of hospital stay were recorded. In the prospective group clinical and radiographic assessments were made at three months and one year. The range of movement of the affected limb was measured and compared to the unaffected side.
There were 47 fractures in the retrospective group and 16 fractures in the prospective. In the retrospective group 94% were treated with traction, and in the prospective group the treatments were, early hip spicas 44%, external fixator 31% and flexible nails 19%. The mean hospital stay was 31 nights in the retrospective group and 16 in the prospective group. In the retrospective group 17% had a mal-union greater than ten degrees, and at three months in the prospective group this was 46%. Clinical follow up at three months in the prospective groups, they all had a full range of movement, and only two had any pain.
The use of varied treatments result in shorter hospital stay which allows children home earlier and reduces the demand on hospital beds. The children returned to normal function with a good range of movement using these modern treatments.
The abstracts were prepared by Wing Commander T. P. S. Bhullar. Correspondence should be addressed to him at the Ministry of Defence Hospital Unit, Edith Cavell Hospital, Bretton Gate, Peterborough PE3 9GZ.
