Childhood femoral fracture can lead to premature knee-joint arthritis. 21-year follow-up results: a retrospective study.
OBJECTIVE
During the past decades, treatment of pediatric femoral fractures in Finland has changed from mostly non-operative to more operative. In this retrospective study, we analyzed the long-term results of treatment.


METHODS
74 patients (mean age 7 (0-14) years) with a femoral fracture were treated in Aurora City Hospital in Helsinki during the period 1980-89. 52 of 74 patients participated in this clinical study with a mean follow-up of 21 (16-28) years. Fracture location, treatment mode, time of hospitalization, and fracture alignment at union were assessed. Subjective assessment and range of motion of the hip and knee were evaluated. Leg-length discrepancy and alignment of the lower extremities were measured both clinically and radiographically.


RESULTS
Of the 52 children, 28 had sustained a shaft fracture, 13 a proximal fracture, and 11 a distal fracture. 44 children were treated with traction, 5 by internal fixation, and 3 with cast-immobilization. Length of the hospital treatment averaged 58 (3-156) days and the median traction time was 39 (3-77) days. 21 of the 52 patients had angular malalignment of more than 10 degrees at union. 20 patients experienced back pain. Limping was seen in 10 patients and leg-length discrepancy of more than 15 mm was in 8 of the 52 patients. There was a positive correlation between angular deformity and knee-joint arthritis in radiographs at follow-up in 6 of 15 patients who were over 10 years of age at the time of injury.


CONCLUSIONS
Angular malalignment after treatment of femoral fracture may lead to premature knee-joint arthritis. Tibial traction is not an acceptable treatment method for femoral fractures in children over 10 years of age.
Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland. sauli.palmu@helsinki.fi
Sauli A
SA
Palmu
Martina
M
Lohman
Reijo T
RT
Paukku
Jari I
JI
Peltonen
Yrjänä
Y
Nietosvaara
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D002370:Casts, Surgical / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D005264:Femoral Fractures / Q000150:complications* / Q000601:surgery / Q000628:therapy; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D020370:Osteoarthritis, Knee / Q000209:etiology*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014143:Traction / Q000009:adverse effects; D055815:Young Adult