Session IX - Pediatrics

External Fixation of Pediatric Femur Fractures. Should We Abandon this Technique?

R. Dale Blasier, MD; Rosalind R. White, RN; Arkansas Children's Hospital, Little Rock, Arkansas, USA

Purpose: Records of a consecutive group of children treated for femoral fractures with external fixation by a single surgeon were reviewed with regard to safety and efficacy of the treatment.

Methods: A retrospective study was conducted of patients treated with external fixation for femur fracture. Information on demographic data, injury mechanism, associated injuries, complications, and leg length was obtained from charts. Data on fracture pattern, location, healing, and deformity were obtained from radiographs.

Results: Forty-five children with a mean age of 8+11 years (range, 3+0 to 14+1) underwent external fixation for femoral fracture from 1995 to 2000. The most common causes of injury were motor vehicle accident (14), car versus bike (7), pedestrian (6), and motorized recreational vehicles (4). Four were open fractures. Twenty-seven children sustained polytrauma, 18 had isolated femur fractures. Twenty-eight had transverse or short oblique fracture patterns, 17 were long oblique or comminuted fractures prone to shortening. One patient died and one moved away; 43 patients were followed to completion of healing. Fixation was maintained from 8 to 20 weeks (mean, 12.8). No fixator was dynamized, but weight bearing was encouraged. There were two treatment failures: one acute refracture within a week of fixator removal due to inadequate callus, and one late bending of the fracture into valgus due to inadequate callus. The remaining 41 fractures (95%) healed uneventfully. Data on leg lengths were available for 20 patients: 9 healed from 2 to 22 mm long (mean, 10.8 mm), 5 healed >from 2 to 15 mm short (mean, 8.4 mm), and 6 were neither long nor short. There was no symptomatic angulation. Five patients were given antibiotics for presumed pin tract infection, and four more had drainage without infection.

Discussion: The method was successful in 95% of cases. Children old enough to have fracture fixation with transverse or short oblique patterns or who resemble adults should have intramedullary fixation. Children age 6 to 12 years with fractures prone to shortening, a deformed canal, or who are too sick for a prolonged anesthesia are excellent candidates for external fixation.

Conclusion: The external fixator is still a useful tool for treatment of selected femur fractures in children but is rarely the first choice of treatment.