[Treatment of diaphyseal femoral fractures in children: a clinical study]

Abstract

Many therapeutic modalities have been reported for the management of femoral shaft fractures in children and young adolescents but there is no consensus on the preferable method.

Purpose: To compare the malunion rate of femoral shaft fractures in children treated either by traction and spica cast or traction and functional brace.

Material and methods: Between 1982 and 1984 a prospective study was carried out in a tertiary pediatric university hospital on 43 patients (24 boys, 19 girls) with a closed femoral shaft fracture. The patient's age ranged from 5 to 13 years old. Open, pathologic, subtrochanteric and physeal fractures were excluded. Fifteen (15) patients were treated by a functional brace and 28 were treated by a spica cast. Clinical and radiological assessments of all patients were performed 5 years or more after the fracture by an independent observer. A malunion occurred if one of these criteria were met: an angulation > or = 10 degrees in the coronal plane, an angulation > or = 15 degrees in the sagittal plane, a malrotation > or = 15 degrees by opposition to the other leg, and a discrepancy > or = 10 mm between femur's length.

Results: A malunion was found in 17 patients, 6 in the functional brace and 11 in the spica cast group (p > 0.05). The leg length discrepancy was the most common type of malunion. The length of stay was not significantly different between both treatment groups. The functional brace was worn longer than the spica cast.

Conclusion: There was no statistical difference between the malunion rate of children treated by traction-spica cast and traction-functional brace. The functional brace appears to be a good alternative for the treatment for femoral shaft fracture in children allowing an earlier ambulation than spica cast.