Three weeks external fixation followed by hip spica cast for femoral shaft fractures in older children and adolescents

ABSTRACT

There has been a recent resurgence of interest in operative stabilization of pediatric femoral shaft fractures in older juveniles and adolescents. External fixation has many advantages especially in polytraumatized patient and in open fractures. Some authors criticize external fixation if used till full union as it may cause nonunion, delayed union, and refracture after its removal. The aim of this study is to evaluate the results of three weeks external fixation for pediatric femoral shaft fractures [6-16 years] followed by hip spica till complete union. Twenty eight femoral shaft fractures in 25 patients were the material of this study. The mean age was 9 years [range 6 - 16 years], with 19 boys and 6 girls. Three patients had bilateral fractures and 3 fractures were open. Eight patients were polytraumatised, and most of fractures were diaphyseal [25 cases]. On admission immediate skin traction was applied over Thomas splint and the patients were referred for radiological examination. All the patients were listed for external fixation next morning except in three cases with open fractures where immediate external fixation was done after thorough debridment and irrigation. The orthopaedic table with traction piece was used in all patients after general anesthesia. A closed reduction or assisted closed reduction using Joy-Stick technique under image intensifier was done. A uniplanar double bar AO tubuIar external fixator with at least two pins proximal and distal to the fracture avoiding the physes was used. Post operative meticulous pin-site care, immediate active hip and knee range of motion were advised, followed by assisted crutch weight-bearing as tolerated. The average length of hospital stay was 5.6 days [range 2-16 days]. Three weeks later a hip spica was applied after removal of the fixator, and radiographs were done every 21 days till complete union. The average time for union was 9 weeks [range 6-15 weeks], with an average follow up period of 18 months [range 3-36 months]. The following complications were reported pin-tract infection [4 cases], angulation >10 degrees in AP view [1 case] angulation >10 degrees in lateral view [3 cases], genu varum [1 case], translation [4 cases], limb-length discrepancy [6 cases], partial loss of reduction [2 cases], and residual knee fiexion deformity about 5 degrees [1 case]. In conclusion applying external fixation for a short period just enough to get the fracture stabilized by soft tissue callus give the patient all its advantages with minimal complications. Also it shortened the period of hospital stay and the cost of treatment