Abstract
Background: Pediatric comminuted femoral shaft fractures are not frequent but difficult in treatment due to concomitant injuries and instability. Although orthopaedic literature is rich in reports on paediatric femoral shaft fractures only few focus on comminuted ones.
Purpose: The aim of the study is to present results and complications of surgical treatment in comminuted femoral shaft fractures during growing age.
Material and Methods: Between 2001–2006 twenty eight children presented with 29 wedge or complex femoral shaft fractures. All children underwent clinical and radiographic examination on follow up and their medical data was retrospectively reviewed. TEN scoring criteria, time to solid union, early and late complications were of the primary interest during follow up assessment.
Results: There were 18 boys (64,3%) and 10 (35,7%) girls. Their mean age during injury was 10,1 years and average follow up period was 35,7 months. In 15 children (53,6%) multiple injuries were present. Three fractures were treated conservatively, the remaining 26 underwent closed or open reduction with stabilization using EBI external fixation, intramedullary Rush or TEN rodding, multiple screws or plate osteosynthesis.
On follow up there were 12 (41,4%) excellent, 14 satisfactory (48,2%), 3 poor (10,4%) results. All fractures united and a mean time to achieve solid union was 20,7 weeks. Leg length discrepancy occurred in 20 children (71,4%), and in 10 (35,7%) was greater than 10 mm. Four children required in early secondary surgical procedures to achieve better alignment or fracture stabilization. One femoral osteomyelitis required in surgical drainage and prolonged intravenous antibiotic therapy.
Conclusions: Comminuted femoral shaft fractures in children heal well after surgical treatment although the risk of serious complications is high. Intramedullary rodding seems to be sufficient in most cases. Screw fixation alone should be avoided.
Correspondence should be addressed to BSCOS c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
