Skip to main content

Advertisement

SpringerLink
Log in

Diaphyseal femoral fractures below the age of six years: Results of plaster application and long term followup

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

In children less than 6 years, the treatment of femoral shaft fracture is often non surgical, using closed reduction and casting. The literature reports many experience about this type of trauma but none of these has a long term followup. We present a retrospective study on a group of femoral diaphyseal fractures treated nonsurgically in children up to 6 years of age, with a minimum of 10 year followup.

Materials and Methods

48 cases (36 males/12 females) with femoral diaphyseal fractures treated between January 1988 and December 1998 were reviewed. Patients with fractures due to obstetrical trauma and pathologic fractures were excluded. The mean age of the patients was 3.3 ± 1.1 years (range 5 months-6 years). Right side was involved in 21 cases (44%), and left side in 27 cases (56%). In 34 cases (71%), closed reduction was performed and hip spica was applied with the hip and knee flexed to 45°. In 8 cases (17%), skeletal traction was applied to perform fracture reduction and the traction pin was embedded in plaster while in the remaining 6 cases (12%), the Delitala pressure apparatus was applied after casting.

Results

All fractures healed in our study. There were no complications (infection or vascular nervous issues, axial deviations, consolidation delays, or pseudoarthrosis). In 13 cases (27%), followup examinations showed mean lengthening of 1.3 ± 0.75 (range 0.5–2.5 cm) of the fractured lower limb. All these patients were treated with skin traction before treatment and presented with 2.08 ± 0.28 cm mean initial femoral shortening. In 1 case (2%) with 2.5 cm lengthening, epiphysiodesis of the ipsilateral knee was performed. No patients showed prolonged difficulty with gait disorders.

Conclusion

On the basis of our results conservative treatment of femoral shaft fractures in children can be considered less invasive and safe procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Hinton RY, Lincoln A, Crockett MM, Sponseller P, Smith G. Fractures of the femoral shaft in children. Incidence, mechanisms, and sociodemographic risk factors. J Bone Joint Surg Am 1999;81:500–9.

    Article  CAS  Google Scholar 

  2. Rush JK, Kelly DM, Sawyer JR, Beaty JH, Warner WC Jr. Treatment of pediatric femur fractures with the Pavlik harness: Multiyear clinical and radiographic outcomes. J Pediatr Orthop 2013;33:614–7.

    Article  Google Scholar 

  3. Podeszwa DA, Mooney JF 3rd, Cramer KE, Mendelow MJ. Comparison of Pavlik harness application and immediate spica casting for femur fractures in infants. J Pediatr Orthop 2004;24:460–2.

    Article  Google Scholar 

  4. Vanlaningham CJ, Schaller TM, Wise C. Skeletal versus skin traction before definitive management of pediatric femur fractures: A comparison of patient narcotic requirements. J Pediatr Orthop 2009;29:609–11.

    Article  Google Scholar 

  5. D’Ollonne T, Rubio A, Leroux J, Lusakisimo S, Hayek T, Griffet J. Early reduction versus skin traction in the orthopaedic treatment of femoral shaft fractures in children under 6 years old. J Child Orthop 2009;3:209–15.

    Article  Google Scholar 

  6. Simons M. The use of the Delitala pressure apparatus. Acta Orthop Belg 1967;33:51–56.

    CAS  PubMed  Google Scholar 

  7. Bruscoli P, Zallocco L, Bartolucci G. The use of the Delitala pressure nail in diphysial fractures. Acta Chir Ital 1966;22:563–80.

    CAS  PubMed  Google Scholar 

  8. Beals RK, Tufts E. Fractured femur in infancy: The role of child abuse. J Pediatr Orthop 1983;3:583–6.

    Article  CAS  Google Scholar 

  9. Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A. Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 1994;25:425–65. 9.

    CAS  PubMed  Google Scholar 

  10. Galano GJ, Vitale MA, Kessler MW, Hyman JE, Vitale MG. The most frequence traumatic orthopaedic injuries from a national pediatric inpatient population. J Pediatr Orthop 2005;25:39–44.

    PubMed  Google Scholar 

  11. Hedlung R, Lidgren U. The incidence of femoral shaft fractures in children and adolescents. J Pediatr Orthop 1986;6:47–50.

    Article  Google Scholar 

  12. Kasser JR, Beaty JH. Fratture della diafisi femorale in Rockwood e Wilkins. Traumatologia Pediatrica. Roma Verduci Ed; 2006. p. 896–901.

    Google Scholar 

  13. Staheli LT. Femoral and tibial growth following femoral shaft fracture in childhood. Clin Orthop Relat Res 1967;55:159–63.

    CAS  PubMed  Google Scholar 

  14. Frech-Dörfler M, Hasler CC, Häcker FM. Immediate hip spica for unstable femoral shaft fractures in preschool children: Still an efficient and effective option. Eur J Pediatr Surg 2010;20:18–23.

    Article  Google Scholar 

  15. Akçahin E, Celebi L, Yüksel HY, Hapa O, Muratli HH, Aktekin CN, et al. Immediate incorporated hip spica casting in pediatric femoral fractures: Comparison of efficacy between normal and high-risk groups. J Pediatr Orthop 2009;29:39–43.

    Article  Google Scholar 

  16. Irani RN, Nicholson JT, Chung SM. Longterm results in the treatment of femoral-shaft fractures in young children by immediate spica immobilization. J Bone Joint Surg Am 1976;58:945–51.

    Article  CAS  Google Scholar 

  17. Staheli LT, Sheridan GW. Early spica cast management of femoral shaft fractures in young children. A technique utilizing bilateral fixed skin traction. Clin Orthop Relat Res 1977;126:162–6.

    Google Scholar 

  18. Cassinelli EH, Young B, Vogt M, Pierce MC, Deeney VF. Spica cast application in the emergency room for select pediatric femur fractures. J Orthop Trauma 2005;19:709–16.

    Article  Google Scholar 

  19. Lebel E, Karasik M, Fisher D, Itzchaki M. Treatment of pediatric femur fractures by immediate reduction and spica cast application - Clinical and economical feasibility in the Israeli medical system. Harefuah 2006;145:731–5, 783, 782.

    CAS  PubMed  Google Scholar 

  20. Schnater JM, Sleeboom C, Raaymakers EL, Ekkelkamp S, Aronson DC. Femoral shaft fracture in children younger than 4 years: Shorter hospital stays with the help of at home traction apparatus. Ned Tijdschr Geneeskd 1998;142:1324–7.

    CAS  PubMed  Google Scholar 

  21. Kanlic E, Cruz M. Current concepts in pediatric femur fracture treatment. Orthopedics 2007;30:1015–9.

    Article  Google Scholar 

  22. Mansour AA 3rd, Wilmoth JC, Mansour AS, Lovejoy SA, Mencio GA, Martus JE. Immediate spica casting of pediatric femoral fractures in the operating room versus the emergency department: Comparison of reduction, complications, and hospital charges. J Pediatr Orthop 2010;30:813–7.

    Article  Google Scholar 

  23. Jauquier N, Doerfler M, Haecker FM, Hasler C, Zambelli PY, Lutz N. Immediate hip spica is as effective as, but more efficient than, flexible intramedullary nailing for femoral shaft fractures in pre-school children. J Child Orthop 2010;4:461–5.

    Article  Google Scholar 

  24. Bopst L, Reinberg O, Lutz N. Femur fracture in preschool children: Experience with flexible intramedullary nailing in 72 children. J Pediatr Orthop 2007;27:299–303.

    Article  Google Scholar 

  25. Lascombes P, Haumont T, Journeau P. Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop 2006;26:827–34.

    Article  Google Scholar 

  26. Saseendar S, Menon J, Patro DK. Treatment of femoral fractures in children: Is titanium elastic nailing an improvement over hip spica casting? J Child Orthop 2010;4:245–51.

    Article  CAS  Google Scholar 

  27. Dietz HG, Schlickewei W. Femoral shaft fractures in children. Unfallchirurg 2011;114:382–7.

    Article  Google Scholar 

  28. Kocher MS, Sink EL, Blasier RD, Luhmann SJ, Mehlman CT, Scher DM, et al. Treatment of pediatric diaphyseal femur fractures. J Am Acad Orthop Surg 2009;17:718–25.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Surgery Department Istituto Giannina Gaslini, Orthopaedics and Traumatology Unit, Largo G. Gaslini 5, 16100, Genova, Italy

    Nunzio Catena, Filippo M. Sénès, Simone Riganti & Silvio Boero

Authors
  1. Nunzio Catena
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Filippo M. Sénès
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Simone Riganti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Silvio Boero
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nunzio Catena.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Catena, N., Sénès, F.M., Riganti, S. et al. Diaphyseal femoral fractures below the age of six years: Results of plaster application and long term followup. IJOO 48, 30–34 (2014). https://doi.org/10.4103/0019-5413.125487

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/0019-5413.125487

Key words

Search

Navigation