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J Child Orthop. 2011 Apr;5(2):101-8. doi: 10.1007/s11832-011-0334-6. Epub 2011 Mar 9.

Open fractures of the femur in children: analysis of various treatment methods.

Abstract

PURPOSE:

To describe the demographic and clinical characteristics of children who presented with open femur fractures.

METHODS:

A retrospective chart review of all children treated for open femur fractures at the McGill University Health Center between 1980 and 2009 was conducted. Thirty-seven patients (28 males and 9 females) were identified. Union was determined clinically by the absence of pain, tenderness to palpation and crepitus with motion. Complications were reported.

RESULTS:

The mean age of the patients was 11.5 years (range 2.8-18.1 years). The mechanism of injury involved motor vehicle-related injuries in 70% of cases. There were 13 Grade I, 15 Grade II and 9 Grade III fractures. The treatment involved traction and hip spica in 11 patients, external fixator in nine patients, intramedullary nailing in seven patients, open reduction and internal fixation in six patients, and traction and an ischial weight bearing brace in four patients. Average time to union was 5.1 months (range 1.5-14.4 months). Infections occurred in ten patients, nine had delayed unions, two developed malunions, four had a refracture and four patients developed a limb length discrepancy >2 cm.

CONCLUSIONS:

Open fractures of the femur are often accompanied by associated injuries, indicating the importance of early and comprehensive treatment. Treatment may include hip spica application in school-age children and solid intramedullary nails in adolescents. In children with multiple injuries, specifically those with higher fracture grades, treatment with an external fixator provides immediate stability of the fracture and allows early mobilization and ease of management of associated injuries.

KEYWORDS:

External fixation; Intra-medullary nailing; Open femur fracture; Pediatric fracture; Traction and hip spica cast; Treatment methods

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