Treatment of femoral shaft fractures in children by external fixation.

Non-operative management is still the treatment of choice for closed fractures of the femoral shaft in children. Indications for operative intervention would include: children with multiple injuries; severe soft tissue damage; cases where reduction is difficult to maintain; and children not suitable for management by traction. Since 1984, 16 children (mean age 10.3 years) have had stabilization of their femoral shaft fractures by external fixation (Monofixateur) in the Trauma Department of the Hannover Medical School. The external fixation remained in place for a mean of 63 days. Of the 16 children, 15 have been reviewed, with a mean follow-up of 28.2 months. No children who were completely managed with this fixation had any clinically relevant malalignment, but six cases had up to 2 cm difference in leg length. Our observations and experience show that external fixation is a useful alternative for the operative management of femoral shaft fractures in children. It produces good stability, is less invasive, and allows early mobilization. In order to avoid differences in leg length, we recommend a good anatomical reduction with the external fixation being carried out as early as possible.