title: Remodeling of angulation deformities in diaphyseal femoral fracture in children.
abstract: BACKGROUND
  The purpose of this study was to reconsider the factors influencing the remodeling effects in diaphyseal femoral fractures in children based on radiological results.
  
  
  METHODS
  We reviewed 39 patients with more than a 5° residual angulation deformity at the fracture site on anteroposterior and/or lateral views at the primary healing stage. The average follow-up period was 30.4 months. Angulation deformity was measured on plain radiographs both at the primary healing stage and the final follow-up. The correction rate (A - B/A × 100, A angulation deformities at the primary healing, B the angulation at the final follow-up) between at the primary healing stage and final follow-up was analyzed in terms of age at injury (0-5, 6-9, and ≥10 years), fracture site (proximal one third, middle one third, and distal one third) and direction of the deformities (coronal and sagittal planes).
  
  
  RESULTS
  The remodeling effect significantly appeared on the coronal plane (correction rate 66.7 %) rather than on the sagittal plane (correction rate 31.6 %) in the 0- to 5-year age group (P < 0.05). There was a statistically significant difference in the correction rate between the 0- to 5-year age group (66.7 %) and the 6- to 9-year group (30.6 %) on the coronal plane (P < 0.05), with no significance between any other two groups on both planes. No statistical difference of remodeling effect appeared among the three fracture sites. The average leg-length discrepancy was 4.7 mm longer.
  
  
  CONCLUSIONS
  We suggest that a patient ≤5 years at injury could expect more sufficient remodeling on the coronal plane compared with the other age groups on both planes. However, a patient >5 years at injury should be encouraged to undergo the maximum possible correction of the angulation deformity at the initial treatment. Surgical intervention might be considered for that purpose.
authors.affiliation: Chiba Child and Adult Orthopaedic Clinic, 3-24-2 Oyumino minami, Midori-ku, Chiba, Chiba 266-0033, Japan. kame-cch@kje.biglobe.ne.jp
authors.forename: Makoto
authors.initials: M
authors.lastname: Kamegaya
authors.forename: Takashi
authors.initials: T
authors.lastname: Saisu
authors.forename: Yuko
authors.initials: Y
authors.lastname: Segawa
authors.forename: Jun
authors.initials: J
authors.lastname: Kakizaki
authors.forename: Yuko
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Shigeo
authors.initials: S
authors.lastname: Hagiwara
mesh_terms: D000367:Age Factors; D001837:Body Weights and Measures; D016723:Bone Remodeling / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018483:Diaphyses / Q000293:injuries; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D017102:Fracture Healing / Q000502:physiology*; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D011859:Radiography; D012307:Risk Factors