Short term outcome of treatment of femoral shaft fractures in children by two methods: Traction plus casting, versus intramedullary pin fixation - A comparative study

There is no consensus on treatment of closed femoral shaft fractures in children 6-12 years old .The aim of this study was to evaluate and compare the short term results of pediatric femoral shaft fractures at above ages with two different methods of treatment: skeletal traction followed by a hip spica cast and surgical treatment by intramedullary pin fixation and to determine which of these methods results in earlier union of fracture and independent ambulation of the patients. This study was performed prospectively at two hospitals during a period of 32 months from 2003 through 2006. Sixty six children with closed fractures of the femoral shaft were treated and followed at least through the time of fracture healing, spica cast removal and onset of unprotected walking in two separate groups: [A] skeletal traction by 90 - 90 technique followed by spica cast [n=30], [B] open reduction and internal fixation with intramedullary pin and cast [n=36]. The length of hospital stay, casting period, union of fractures, time to start walking and the rate of complications was evaluated and compared using Chi-Squar test. Mean age of all patients was 7.4 years old. Average follow-up was 6 months. Healing of the fractures was observed in all cases of both groups between 8 and 12 weeks. The length of immobilization was longer in traction versus surgery group. Average treatment duration from admission to hospital till independent walking was 75.3 days for the traction and 61.2 days for surgery group. Limb shortening and malrotation were more in traction versus intramedullary pin patients. Both methods of traction plus spica casting and intramedullary pinning can be used to treat femoral shaft fractures in 6-11 years old children. Intramedullary pin due to its less hospital stay, earlier walking and less complication rates can be used as the first choice in treatment of this fracture at school aged children