Management and outcome of diaphyseal femur fracture in Children: A tertiary care Experience

Introduction: In children fractures of the femoral shaft are commonly treated by various types of traction for about 3 weeks, followed by plaster cast immobilization. However little is known about the functional outcome and its complication in Indian scenario. Therefore our aim of study was to analyse the functional outcome in femoral shaft fractures of children operated by flexible intramedullary nails. Material and Methods: In this study 40 patients, aged 5 to 16 years, with fracture shaft of the femur visiting at department of orthopaedics of a tertiary care centre, Indore in the period from September 2012 to September 2014. Patients with comminuted and segmental fractures, Type III Compound fractures and very distal (or) very proximal fractures that precludes nail insertion were excluded from the study. Observations were made regarding the alignment of the fracture, the range of motion of knee and hip, limb length discrepancy, degree of pain or swelling and rotational deformity of the femur. Results: The mean time interval between trauma, and surgery was 2-4 days.In 80% of cases stainless steel nails were used and in remaining 20 % of cases titanium nails were used. Selection of nails was done based on patient affordability.In most of the cases (50%) 2.5 mm diameter nails were used. 3 mm nails were used in 35% of the cases and in other 10% cases 3.5 mm were used. Only in two cases 2 mm nails were used. Mean Hospital stay was 11.4±3.05 days. Conclusion: The advantages of the present study include minimal scarring, closed reduction, load sharing device, fracture heals by secondary callus formation which is strongerand refracture is not a risk. Rigid intramedullary nailing is also described in the management of femoral shaft fractures.