Effect of rotational deformities after pediatric femoral fracture on clinical outcome

Abstract

Femoral shaft fractures are the most common pediatric injuries that require hospitalization. Early closed reduction and spica casting are one of the most popular treatment options. One of the significant complications of spica casting is rotational deformities of the fracture. The present study aimed to determine the potential effects of rotational deformities in pediatric patients who underwent early spica casting after a femoral shaft fracture. Pediatric patients who underwent early spica casting following femoral shaft fractures were screened retrospectively. Radiological measurements were made on the patients' initial postop radiographs who could be measured rotationally according to the defined radiological method. Twenty-three patients with more than 10° of rotation in their measurements were included in the study. Differences in leg length and rotation between both legs were calculated with clinical examination methods for all patients in the study. The gaits of the patients were observed; patient and family complaints were obtained. We found a strong and positive correlation between the rotational measurement made on the X-ray and the clinical measurement (R: 0.634, P: 0.001). For measurements made on X-ray, the mean rotational value was calculated as 27.2 ± 6.9 degrees. After the patients' clinical examination, an average of 3.0 ± 1.7 degrees rotational difference was found between the broken limb and the healthy limb. No patient or family complained of trauma. Early spica casting, according to the age of the patient, is an effective treatment method. There may still be certain degrees of deformity after treatment, but patients well tolerate them even at high degrees. Accordingly, it was concluded that the rotational deformities less than 30 degrees would not cause clinical problems on children under 4 years of age which may require postoperative revisions or the use of various costly imaging techniques and include radiation.

Elastic Stable Intramedullary Nailing in Length Stable Versus Unstable Pediatric Femoral Shaft Fractures: A Comparison of Clinical, Radiographic, and Pedobarographic Outcomes

“…[20][21][22] On the other hand, little is known about the limits of tolerability and compensation to rotational malalignment as well as its clinical implications and long-term consequences. 23 Previous studies used computed tomography (CT) to measure postoperative femoral anteversion. 19,24 Although CT is the most accurate tool to evaluate rotational deformities of the lower limb, its routine use in children is inappropriate due to radiation exposure.…”

What’s New in Limb Lengthening and Deformity Correction

“…This step helps to avoid failed retrieval when extracting or exchanging the Fassier-Duval rods 72 . ˙Igrek et al determined that residual rotational deformities after femoral shaft fractures treated with spica casting that measured <30°would not cause clinical problems for children who were <5 years of age 73 . Elizondo et al described a single-incision percutaneous epiphysiodesis technique using a 9-mm cannulated reamer and angled curets.…”

Intraoperative Angle Measurement of Anatomical Structures: A Systematic Review

“…Although most instances of congenital deformities are resolved naturally and do not persist past adolescence, they can still exist in adults [ 1 , 2 , 3 ]. Additionally, deformities are not exclusively a congenital condition and can be found also as a result of trauma or in a pathological context [ 3 , 5 ]. In the best case scenarios, the deformities naturally correct, and it is possible to live without knowing there ever was such a problem.…”

“…In the best case scenarios, the deformities naturally correct, and it is possible to live without knowing there ever was such a problem. However, there are cases where the deformities have been linked with pain and changes in biomechanical parameters, such as movement impairments, limb range of motion (RoM) deficiencies, and muscle incapabilities [ 3 , 5 , 6 , 7 ]. When the deformities lead to those conditions, a surgical correction is sometimes necessary [ 1 , 2 ].…”