External Fixation of Displaced Femoral Shaft Fractures in Children: A Consecutive Study of 98 Fractures

Abstract

The use of external fixation as a standard treatment of uncomplicated displaced femoral shaft fractures in children gave satisfactory results. The surgical learning curve was short, and the advantages compared with nonsurgical treatment included shorter hospital stay, early mobilization, and fewer days out of school for the patient and out of work for the caregiver. We believe that the advantages far outweigh the complications, many of which can be avoided.

Surgical treatment of femoral fractures in childrenComparison between external fixation and elastic intramedullary nails: A review

“…Some authors have stated that external fixation should only be used in open fractures or in patients with multitrauma (Alonso et al 1989, Kirschenbaum et al 1990, Krettek et al 1991, van Tets and van der Werken 1991, Gregory et al 1996. Other authors have advocated general use of external fixators when treating femoral fractures in children, as the advantages were found to be greater than the disadvantages of the complications (Aronson and Tursky 1992, Evanoff et al 1993, Blasier et al 1997, Skaggs et al 1999, Hedin et al 2003 (Figure 2).…”

“…For the remaining pins, the ideal solution would be to place them as far away from the first pins as possible, but the distance in the clamps sets a limit for how far away the pins can be placed. Full weight bearing can be allowed as soon as the child wants it, irrespective of age, fracture level or fracture type (Hedin et al 2003).…”

“…Dressing should be minimal and foam rubber sponges can be used (Figure 3). Oral antibiotics can be given for a short period if there are signs of inflammation around the pins (Hedin et al 2003). The fixator can be removed when the fracture is clinically stable (fully pain-free weight bearing, and stable when tested without the fixator with the pins still in place) and the radiographs show bridging callus formation in at least three out of four cortices shown on the radiographs in the lateral and anterior-posterior view (Skaggs et al 1999).…”

“…The external fixator can be used in very small children, but it is usually considered when the child is too heavy for skin traction, which is around 3 years of age. The external fixator can be used instead of inserting a pin for traction or using a spica cast (Hedin et al 2003).…”

“…EF can be used from the inferior edge of the lesser trochanter to 2 cm proximal to the distal femoral physis (Hedin et al 2003).…”