External Fixation of Pediatric Femoral Shaft Fractures Treatment and Results of 121 Fractures

Abstract

From 1988From to 1996 femoral shaft fractures in children were treated by external fixation. The average age was 8.4 years (range: 2 to 16 years). Thirty-three children sustained multiple injuries (27%), and 13 children had 2nd-or 3rd-degree open fractures (10.7%). This study not only analyzes the expenditure of the operation and the corresponding follow-up period, but also the complications and the final results. The average operation time was 1 h (range: 0.2 to 2.8 h). The infection rate was 6.6%. Removal of the external fixator was carried out in 35.5% of the cases on an outpatient basis. Refractures were noted in 7 cases (5.8%). The time of consolidation was 55.3 days on average (range: 36 to 94 days) and depended on the fracture type as well as on the fixator type. By using the dynamic fixation models the consolidation time could be reduced to 46 days in comparison to the stiff AO fixation models with a mean consolidation time of 68 days. Oblique and transverse fractures showed an average healing time of 54 days. Complications such as refractures, infections, delayed unions and changes in therapy mainly occurred after oblique fractures. The average follow-up time was 32 ± 18.7 months (range: 24 to 64 months). The extent of leg length differences, on average 1.3 cm, depended on the delay of surgical intervention. There was no clinical evidence of malangulation (by definition > 20°). The results do not differ from other operative procedures. The external fixator proved to be a valuable method for the treatment of pediatric femoral shaft fractures: hospital stay is reduced and full weight bearing can be achieved early. However, transverse fractures, which showed the highest complication rate, should be treated by intramedullary nailing.

Pitfalls in the Treatment of Femoral Shaft Fractures during Growth - the Role of Communication

“…A more subtle analysis of our patients' results concerning the 50 children treated with flexible intramedullary nailing and the 49 children treated with immediate hip spica, is being prepared but not published yet. A differentiated analysis of most of the 80 children treated with external fixation is included and demonstrated in a multicenter study [16]. Figures 1a and 1b) The fracture was "reduced" under general anesthesia and put in an immediate hip spica cast with accepted shortening of 2 cm and correct alignment.…”

“…Transverse femoral shaft fractures are questionable indications for external fixaton [16]. When using the method in this case, the patient and her parents should have to be informed about the potential delayed bony union with consecutive delayed implant removal.…”

“…Proposal for Improved Treatment. A transverse diaphyseal fracture is a questionable indication for external fixation [16]. The pins were placed too far away from the fracture site with diminished mechanical stability and subsequent redislocation.…”

Fixateur externe-Versorgung von instabilen kindlichen Femurdiaphysenfrakturen: 10-Jahres-Erfahrung

“…Lebensjahr hauptsächlich die Extensionsbehandlung, z. B. mit Overhead-Extension und Weberbock, angewandt wird, werden ältere Kinder zunehmend operativ behandelt [9,23,26,27]. Ausschlaggebend für den Therapiewandel sind die unzufriedenstellenden Ergebnisse der konservativen Behandlung mit hohen Komplikationsraten: in Fehlstellung ausgeheilte Frakturen, Beinlängendifferenzen nach mehrfachen Nachrepositionen, mehrfache Narkosen, Refrakturen [12,18,22].…”

“…Gegen eine Markraumschienung sprechen jedoch Weichteilirritationen an den Nageleintrittsstellen, postoperativ zunächst meist nur die Möglichkeit einer Der Fixateur externe ist ebenfalls ein weichteilschonendes, minimal invasives Verfahren, dessen Vorteile in einer raschen operativen Versorgung, der Korrigierbarkeit eines postoperativen Rotationsdefizites, der Möglichkeit der vollen Belastung, einem kurzen stationären Aufenthalt sowie der universellen Anwendbarkeit auf alle Frakturtypen bestehen [1,8]. Nachteilig sind beim Fixateur externe Pininfekte, die erhöhte Refrakturrate, der schlechte Tragekomfort und die erforderliche hohe Patienten-Compliance [20,27].…”