ACTA FAC. MED. NAISS. 2004; 21 (3):143-151

     Original article

Dragoljub V. Živanović¹, Nina Đorđević¹, Zoran Marjanović¹, Milorad Mitković²

¹Paediatric surgery and orthopaedic Clinic, Clinical centre Niš, Serbia and Montenegro,
²Orthopaedic Clinic, Clinical Center Niš, Serbia and Montenegro

    Femur fractures are the most common major skeletal injury in pediatric population. These fractures typically occur either in early childhood or during adolescence. The majority of these fractures in children heal satisfactorily regardless of treatment method. Spica casting, or traction followed by spica casting, has been used with great success but in the past decade more aggressive approach such as internal and external fixation has been developed to reduce treatment costs and adverse effects of prolonged immobilization. Decision making is based on consideration of age, sex, fracture location and pattern, understanding of remodelation potential and socioeconomic characteristics of the child and his or her family.
    In the four-year-period 75 children (77 femora) aged 6 months to 15 years were treated with different methods for femoral fractures. Sixty-six children (68 femora) met the inclusion criteria. Spica casting (31), traction followed by spica casting (4), open reduction and compression plating (12), external fixation with Mitkovic M.20 fixator (20) and IM nailing (1) were the treatment methods.
    Each method has its clear advantages and disadvantages. On the basis of the results of our investigation and review of the literature we developed following treatment recommendations: children younger than 6 years can be satisfactorily treated with immediate closed reduction and spica casting. If the initial displacement is greater than 2cm or the telescoping test is positive a period of traction is recommended. In older children with long spiral or comminuted fractures with large free fragment as well as in polytraumatised children external fixation is the treatment of choice. In older children with displaced transverse or short oblique fractures and in children with severe head trauma compression plating is a better treatment option. Rigid intramedullary nailing should be abandoned due to high risk of avascular necrosis. Elastic intramedullary nailing with titanium or Ender nails should be considered as the best treatment method but the expenses and lower axial and rotation stability represent its major disadvantages. Minimally invasive percutaneous plating and internal fixator are the methods that should be evaluated in the future as potential options for treating femoral fractures in children.

Key words: femoral fractures, children, external fixation, compression plating,closed reduction