Limb length discrepancy following fracture of the femoral shaft in children

Limb discrepancy could be considered the most frequent complication of femoral shaft fracture in children. This paper reviews the literature concerning the possible mechanisms of growth stimulation and the correlations between overgrowth and age, site and type. In a review of 41 children aged between 0 and 13 years with simple femoral shaft fracture, treated at the Royal Liverpool Children's Hospital between 1973 and 1979, who had a radiological 'grid film' and/or a clinical measurement, a final check showed a limb discrepancy in almost 50% of the cases. These data reveal that no overgrowth occurred in patients who sustained the fracture below the age of 1 year, while those over the age of 1 showed a range of overgrowth of 0.5-2.0 cm. It was concluded that almost anatomical reduction is advisable in children below the age of 1 year, while in those aged 1-13 years an overlap of 1 cm is ideal

Ipsilateral simultaneous femoral shaft and femoral neck fracture: valuable diagnostic signs

When fractures of both shaft and neck occur in the same femur the neck fracture is often missed; this may lead to complications such as avascular necrosis and non-union. Management of this fracture combination can be successful provided the diagnosis is made early. This paper is presented to demonstrate valuable diagnostic signs to avoid missing the femoral neck fracture; it is based on a clinical and radiological study of 8 patients with this fracture combination. The presence of an associated femoral neck fracture should be suspected if there is fullness and tenderness in the groin or over the greater trochanter of the affected limb. Radiologically, medial displacement of the proximal fragment of a transverse fracture of the shaft is almost always diagnostic of the associated hip injury