May external fixator be an appropriate alternative therapeutic option in pediatric femur fractures?

Abstract

Objective: Our aim was to evaluate the outcome of external fixation in pediatric femur fractures. Material and Methods: Seventeen children (11 males, 6 females) with isolated closed fractures were treated on the day after admission by closed reduction and unilateral external fixator. Fourteen cases had fractures on left side, nine were due to traffic accident and the rest was due to fall. All of the fixators were routinly dynamized at sixth week of surgery. Mean age was 8.3 (range: 6-11), and mean follow-up period was 12 months (range: 7-18). Results: Mean operation time was 27 minutes (range: 18-40), and mean duration of hospitalization was 1.7 days (range: 1-3). External fixators [nine Orthofix type, eight limb reconstruction system (LRS) type, randomly] were applied with cortical contact and all were removed by a mean healing time of 73 days (range: 51-95). Five cases (29.4%) developed pin-tract infection and treated with oral antibiotics and by changing wound dressing frequently. On follow up, no cases of nonunion, malunion, or limitation in range of motion for hip and knee joints were noted. Rotational deformity were not seen in any cases, and average angulation at fracture site was 3.4 degrees in anteroposterior plane and 3.8 degrees in lateral plane radiographs (range 0-8 degrees). One child (5.9%) had mid diaphyseal refracture two months after removal of fixator. There was no overgrowth but three patients (17.6%) had a true shortness of 0.5 cm. Conclusion: Hip spica casting is still the most commonly used method in pediatric femur fractures. Nonetheless, in order to avoid complications secondary to such methods and to allow for early ambulation, we believe that osteosynthesis via external fixator can be a good alternative in the treatment of pediatric femur fractures. © 2010 by Türkiye Klinikleri.