title: Radiological outcome after external fixation of 97 femoral shaft fractures in children.
abstract: The aim of this prospective, consecutive study was to assess overgrowth and malunion after anatomical reduction and external fixation of displaced femoral shaft fractures in children. Ninety-seven closed femoral fractures in 95 children aged 3-15 were fixed with a unilateral external fixator and followed with conventional radiographs and standardized orthograms for 1 year. To evaluate further overgrowth and remodelling a subgroup of 45 patients was also seen at 2 years. Parameters known to influence overgrowth and remodeling were recorded.Eighty-six percent of the femora had an angulation less than 10 degrees in varus/valgus or recurvatum at the time of healing. The remaining fractures remodeled nearly completely. Leg length discrepancy was on average 0.1cm at 1 year. The mean overgrowth was 0.3 cm at 1 year and 0.5 cm at 2 years. Overgrowth and remodeling was not correlated to whether the leg healed in a shortened or lengthened position, nor was it correlated to pin site infection or re-reduction.The overgrowth was far less than expected when compared with previous studies using traction. When external fixation is used in femoral fractures in children, we therefore, recommend fixing the fracture without shortening regardless of the age of the child, type of fracture, fracture level or injury.
authors.affiliation: Department of Orthopaedics, Falun Hospital, Falun, Sweden. hanne.hedin@Itdalarna.se
authors.forename: Hanne
authors.initials: H
authors.lastname: Hedin
authors.forename: Kerstin
authors.initials: K
authors.lastname: Hjorth
authors.forename: Sune
authors.initials: S
authors.lastname: Larsson
authors.forename: Stefan
authors.initials: S
authors.lastname: Nilsson
mesh_terms: D000293:Adolescent; D016723:Bone Remodeling / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D016267:External Fixators / Q000009:adverse effects; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005269:Femur / Q000254:growth & development*; D017102:Fracture Healing / Q000502:physiology; D017759:Fractures, Malunited / Q000503:physiopathology; D006801:Humans; D007870:Leg Length Inequality / Q000503:physiopathology; D008297:Male; D011446:Prospective Studies; D011859:Radiography