Remodelling of angular deformity after femoral shaft fractures in children

Abstract

We reviewed 28 children with unilateral middle-third fractures of the femoral shaft who had an angular deformity after union of 10 degrees to 26 degrees. At an average follow-up of 45 months (20 to 66), we measured remodelling of the proximal physis, the distal physis and the femoral shaft. The average correction was 85% of the initial deformity. We found that 74% of correction occurred at the physes and only 26% at the fracture site. Neither the direction nor the magnitude of the angulation much influenced the degree of remodelling. Younger children remodelled only a little better than older children. We conclude that in children under 13 years of age, malunion of as much as 25 degrees in any plane will remodel enough to give normal alignment of the joint surfaces.

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

“…Most authors see no advantage in prophylactic shortening of the fracture in order to reduce the differences in leg length [8,9,11,12]. Most publications show a leg length discrepancy between 0.5 and 2.5 cm, although an idiopathic factor of 0.7 cm must be taken into consideration [7,17,38]. A study by Kregor et al which [20] included 37 patients with intramedullary nailing, documented a leg length difference in 22% of the cases, with the average difference being more than 5 mm.…”

“…All documented malangulations were less than 15°a nd, according to the literature, clinically irrelevant [27,28,32,38]. Wallace et al [38] showed a correction in 85% of the patients with 10°-angulation or more and came to the conclusion that a malangulation of 25°had enough corrective potential to prevent a shift of the joint axis.…”

“…Despite good results, this treatment modality was abandoned. The decisive factors for this change in treatment were the child's requirements, an adequate treatment concept and economic aspects [1,6,9,12,14,15,19,20,24,38]. A child-oriented therapy should aim at a short hospital stay and an early mobilitation to be able to play or to go back to school.…”

Clinical application of locked plating system in children. An orthopaedic view

“…The majority of remodelling occurs by reorientation of the growth plates. Asymmetrical and longitudinal growth of the physis contribute to it [9]. Remodelling capacity depends on the number of years of growth remaining ahead, the proximity of the fracture to a rapidly growing physis, the magnitude of angular deformity, and the plane of angulation relative to adjacent joints.…”

Fracture of the femur in children

“…In this respect, internal fixation is more certain to achieve an acceptable reduction than either external fixation or splintage. Long-term reviews of remodelling such as that of Wallace and Hoffman 2 show that an initial angular deformity of even 25° can recover to give normal function. Overgrowth is more likely after an operation, although the importance of length discrepancy may have been overrated unless it reaches 2 cm or more.…”