A total of 11 children [six boys and five girls; mean age: 7.2 years (range, 5–12)] qualified the selection criteria and were included in this study (Figures 1–11). All patients had sustained femoral shaft fracture in a road traffic accident. None of the patients were treated by one-stage surgery. The follow-up time ranged from 3 months to 45 months. During the follow-up period, strong healing with blurring or disappearance of the fracture line was observed on x-rays. None of the patients developed pressure sores, infection, osteomyelitis, delayed healing, or nonunion (Table 2).
Seven patients had varying degrees of angulation deformity at the fracture end. Six patients had sagittal angulation while 2 patients had coronal angulation deformity. One patient developed redness and swelling around the nail canal. Two patients developed joint dysfunction, 4 patients had abnormal gait, while 4 patients had varying degrees of limp because of unequal length of lower limbs. Functional recovery was satisfactory in the remaining patients.
Seven patients recovered very well. However, the remaining 4 patients had slightly poor outcomes. Their details are summarized below.
Figure 2 shows the x-ray of a patient who presented with bilateral femoral shaft fracture with comminution of the left femoral shaft. Post-treatment residual length difference between the two lower limbs was approximately 0.5 cm and the patient walked with a limp (Figure 2). Figure 3 shows the x-ray of a patient who presented with fracture of different parts of the femur on both sides, and the right proximal femur had a comminuted fracture. Moreover, the limb length discrepancy was approximately 4 cm, and patient walked with a limp. Post-treatment, hip joint mobility was affected by hip varus deformity. Figure 1 shows the x-rays of a patient who presented with comminuted femoral shaft fracture with central nervous system injury. One year post-treatment, he showed limb shortening with healed deformity. In addition, there was overlapping and lateral angulation at the fracture site (Figure 1). Another patient had sustained a transverse fracture of the right femoral shaft. His right lower limb was shortened by approximately 0.5 cm with a sagittal angle of about 30° after one and a half years of treatment; the patient walked with a slight limp (Figure 4).
Case 1: A 9-year-old boy suffered from central nervous system injury, epidural hemorrhage, contusion of both lungs and spleen, and fracture of the left femoral shaft. He was admitted to the ICU of our hospital. The child was delirious at admission, accompanied by acute central system damage and shock. His vital signs were: heart rate, 164 beats/minute; respiratory rate 30/minute; oxygen saturation (pulse oximetry), 84%; blood pressure, 110/64 mmHg. He was intubated and placed on ventilatory support. Blood transfusion and antibiotics were administered to maintain vital signs. Each department considered conservative treatment after consultation. Femoral shaft fracture was treated with tibial tubercle bone traction. Eight days later, his vital signs gradually stabilized, and he was transferred to the common ward. Review x-ray showed satisfactory alignment and signs of callus formation. His parents requested conservative treatment. Finally, he was discharged from the hospital after plaster fixation (Figure 1).
Case 2: A 5-year-old girl sustained severe injuries in a road traffic accident which included lung contusion, spleen contusion, right femoral fracture, left supracondylar fracture of humerus, and multiple skin contusions. The girl was in shock at admission and was admitted to the ICU of our hospital. Her heart rate was 143 beats/minute and blood pressure was 96/55 mmHg, which gradually decreased to 79/47 mmHg. She was placed on ventilator support after endotracheal intubation. Symptomatic treatment such as blood transfusion and antibiotics were administered to maintain vital signs. After consultation with various departments, a conservative line of treatment was adopted. Tibial tubercle bone traction was applied for the right femoral fracture. Owing to gradual stabilization, she was transferred to the general ward after 13 days. X-ray showed callus formation at the fracture site. Since the operation time was lost, conservative treatment was continued. The patient was discharged after replacing plaster fixation at four weeks (Figure 4).