Functional Outcome of Paediatric Diaphyseal Fractures of Femur Treated with Closed Reduction and Multiple K Wire Fixation.

ABSTRACT

Background: Diaphyseal fracture of the femur in children is one of the common causes of paediatric morbidity. These fractures in children above the age of five years, depending upon the fracture personality, can usually be managed satisfactorily using different intramedullary implants, including Kirchner wires, Rush nail, as well as extramedullary implants using various combinations of plates and screws. Each of these methods of fracture fixation has its own merits and demerits. The current study is aimed at assessing the efficacy of internal fixation of these fractures using closed reduction and percutaneous ‘K’ wire fixation. Methods: Twenty six (n=26) children with a mean age of 7.2 years (range 5-14 years) were treated using closed reduction and multiple percutaneous K wire fixation under image intensifier. The minimum follow up period was twelve months. The final clinical and radiological assessment of patient was done at the end of one year. Three patients (n=3) were lost to final follow-up and were excluded from the final statistical calculations. Results: Twenty one fractures (n=21) united at an average time interval of 4.1 months (range 3- 6.5 months). Two patients had delayed union and one had malunion. Superficial wound infections were seen in two (8.7%) patients. Impingement of bent k wires was felt by another two (8.7%) patients. Stiffness of the knee joint was seen in three patients (13%) during follow-up. Out of three (n=3) patients with knee stiffness two responded well to vigorous physiotherapy programme, while one (n=1) patient had limited knee range of motion even at the final follow-up. Malunion was seen in one (n=1) patient. Conclusion: Closed reduction and percutaneous K wire fixation is a safe, economical, technically non-demanding and highly efficacious technique for the treatment of paediatric femoral diaphyseal fractures.