Childhood femoral fracture can lead to premature knee-joint arthritis. 21-year follow-up results: a retrospective study

Abstract

Background and purpose: 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.

Patients and 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.

Interpretation: 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.

Figure 1.

Age distribution of the 74 children treated for femoral fracture during the years 1980–89. Black color indicates patients with knee-joint arthritis at the final check.

Figure 2.

Standing weightbearing radiographs of the left leg in a 36-year-old patient, who at the age of 14 sustained a distal femoral shaft fracture, which was treated with tibial skeletal traction. AP (a) and lateral view (b) show severe degenerative (grade-II) changes in the tibiofemoral joint.

Figure 3.

Angular deformity (degrees) in patients with and without knee-joint arthritis at follow-up.