Abstract:
Objective: The aim of the study is to evaluate the result of treatment of femoral shaft
fractures in children using external fixation.
Subjects and method: During the period from March 2005 to September 2006,
eighteen children with nineteen femoral shaft fractures treated with External Fixation
(Ex. Fix.) were prospectively studied. The age of patients ranged from 6-16 years,
with male: female ratio of 15: 3. The mechanism of injury was road traffic accident in
all cases. There were six children with multiple injuries (33%). Patients were received
in emergency room where preliminary skin traction and Thomas splint were applied
for few days, then under general anesthesia and on traction table under image
intensifier, closed reduction was performed, shortening of 1-1.5cm was accepted but
no rotational or angular deformity accepted . Ex. Fix. Was applied after draping using
two pins inserted proximally and other two inserted distally and connected by two
bars. Anteroposterior and lateral X-rays taken and dressing done. We used two
systems of external fixation; I- Hoffman and II- Synthes (AO). The average time of
operation was 30 minutes. The average follow up period was 22 months. During
follow up Pin track infection, radiological and clinical union, malunion, overgrowth,
shortening, and stiffness of adjacent joint were ascertained.
Results: All fractures united in 4-16 weeks then Ex. Fix. Was removed. Pin track
infection grade III reported in 8 patients (42%), treated with daily dressings and oral
or IV antibiotics. Overgrowth of 1 cm reported in 4 cases (21%), no patient developed
shortening of the limb. Stiffness of the adjacent joint was reported in all patients and
treated with physiotherapy, and full range of motion was regained. There were two
refractures (10.5%) occurred through the previous fracture site after removal of the
device ,treated with ORIF using DCP. No bone infection was seen.
Conclusion: It is an excellent method for restoring the alignment without exposure of
the fracture site and this helps fracture union. It is relatively quick operation with
minimal blood loss. External fixation can be considered good option for children with
multiple trauma or head injuries.