Indications and results of operative treatment of femoral shaft fractures in children.

In the literature a number of risks due to operative treatment of femoral shaft fracture in children have been reported and justification for such treatment has been thrown into doubt. In our patient series 35 out of 191 children (18%) with femoral shaft fracture were treated by operation, 18 by intramedullary nailing, 16 by other means of osteosynthesis and one crushed extremity by primary amputation. No infections occurred. Nineteen patients of these were re-examined 4.5 to 13.9 years later. Eleven of them had no subjective complaints. Weakness of the fractured limb was suffered by 2 in normal life and by an additional 6 patients in hard exercise. Muscle atrophy of the thigh, more than 2 cm in circumference, was found in 9 patients. Mean longitudinal overgrowth of the fractured femur treated by operation was 9.8 mm corresponding to 10.7 mm in 52 patients treated by traction and casting. Overgrowth of 7.2 mm in intramedullary nailed patients was significantly less (P less than 0.001) than 13.5 mm in those treated by other means of osteosynthesis. A rigid fixation of the fracture partly prevented later spontaneous correction of angulation. Based on the results gained by previous author and from this study a list of indications for osteosynthesis of femoral shaft fracture in children is considered.