Radiological outcome after external fixation of 97 femoral shaft fractures in children

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 10degrees in varus/valgus or recurvatum at the time of healing. The remaining fractures remodeled nearly completely. Leg length discrepancy was on average 0.1 cm 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. (C) 2003 Elsevier Science Ltd. All rights reserved.