J Mutimer1, R D Hammett, J D Eldridge. 1. Bristol Royal Infirmary, Upper Maudlin Street, Bristol, BS2 8HW, UK. jonmutimer@doctors.org.uk
Abstract
INTRODUCTION: Femoral overgrowth is a recognised phenomenon following fractures of the femoral diaphysis in children. This study was designed to assess leg length discrepancy (LLD) following elastic stable intramedullary nailing (ESIN) and its clinical significance. MATERIALS AND METHODS: A retrospective review of children who underwent ESIN with DePuy ACE Nancy nails between 1997 and 2001 for diaphyseal femoral fractures. Evaluation was by questionnaire, clinical examination and radiological measurement. RESULTS: 17/26 (65%) patients were followed up for a mean time of 48 months (21-77). Average age at surgery was 9 years. Mean operative time was 78 min with a mean hospital stay of 7.8 days. Mean time to union was 10 weeks. A statistically significant LLD of +3.2 mm is demonstrated in children aged 4-8 years (P = 0.05). LLD is not statistically significant in children over 8 years. CONCLUSION: ESIN is a successful treatment for paediatric diaphyseal femoral fractures and allows early mobilisation and discharge. A statistically significant LLD is observed in children aged 4-8 years although clinically only one patient in the entire series was aware of a leg length discrepancy. In addition clinical methods of leg length measurement are sensitive for LLD and we conclude that routine radiographic follow up is not necessary unless clinically indicated.
INTRODUCTION:Femoral overgrowth is a recognised phenomenon following fractures of the femoral diaphysis in children. This study was designed to assess leg length discrepancy (LLD) following elastic stable intramedullary nailing (ESIN) and its clinical significance. MATERIALS AND METHODS: A retrospective review of children who underwent ESIN with DePuy ACE Nancy nails between 1997 and 2001 for diaphyseal femoral fractures. Evaluation was by questionnaire, clinical examination and radiological measurement. RESULTS: 17/26 (65%) patients were followed up for a mean time of 48 months (21-77). Average age at surgery was 9 years. Mean operative time was 78 min with a mean hospital stay of 7.8 days. Mean time to union was 10 weeks. A statistically significant LLD of +3.2 mm is demonstrated in children aged 4-8 years (P = 0.05). LLD is not statistically significant in children over 8 years. CONCLUSION: ESIN is a successful treatment for paediatric diaphyseal femoral fractures and allows early mobilisation and discharge. A statistically significant LLD is observed in children aged 4-8 years although clinically only one patient in the entire series was aware of a leg length discrepancy. In addition clinical methods of leg length measurement are sensitive for LLD and we conclude that routine radiographic follow up is not necessary unless clinically indicated.