Abstract
Management of femoral shaft fractures in the transitional age group (8 to 14 years) remains controversial. The aim of this retrospective review of 50 consecutive patients was to evaluate the outcomes of various treatment methods.
Fifty patients (39 boys and 11 girls) with femoral shaft fractures treated between January 1998 and March 2003 were followed-up for a mean period of 30 months (9 to 54), using clinical and radiological parameters as well as patient questionnaires. Motor vehicle accidents had caused the femoral fractures in 56%. The fractures were closed in 88% of the patients and there were associated injuries in 16%.
Depending on the degree of comminution and fracture pattern, patients were treated in one of five ways: initial traction, manipulation under anaesthesia and spica immobilisation (16 patients), non-locking nail (18 patients), locking nail (10 patients), plate and screws (four patients) and external fixation (two patients). The mean time to union was 11 weeks (9 to 28). There was an 8% reoperation rate. Complications included limb length discrepancy in eight patients, malrotation in eight, angulation in 12, entry site pain in five, ectopic calcification in six, delayed union in three, knee stiffness in six and scar problems in four. The mean time away from school was 6.5 weeks (2 to 20). At the last follow-up 86% of patients were satisfied with the outcome.
The use of non-locking nails is cost effective, and healing time with non-locking nails is no longer than with locking nails.
Secretary: Dr H.J.S. Colyn, Editor: Professor M.B.E. Sweet. Correspondence should be addressed to SAOA, Box 47363, Parklands, Johannesburg, 2121, South Africa.
