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Published on: April 11, 2012
The use of external fixators in the immobilization of pediatric fractures
D Norman1, B Peskin, A Ehrenraich
1Pediatric Orthopedics Unit, Rambam Medical Center and Faculty of Medicine, Technion - Israel Institute of Technology, PO Box 9602, Haifa 31096, Israel. bialikv@hotmail.com
Insights
External fixation is a viable option for immobilizing pediatric long bone fractures, offering good alignment and range of motion. This method is particularly useful for comminuted fractures and children with polytrauma.
Area of Science:
- Orthopedic Surgery
- Pediatric Traumatology
Background:
- The management of diaphyseal and metaphyseal fractures in children presents various treatment options, including casting, traction, internal fixation (flexible rods, plating), and external fixation.
- The efficacy and appropriateness of external fixation for pediatric long bone fractures remain a subject of ongoing debate.
Purpose of the Study:
- To evaluate the effectiveness of external fixation in treating diaphyseal and metaphyseal fractures of the lower limb in children.
- To assess functional outcomes, including range of motion and limb alignment, following external fixation treatment.
Main Methods:
- A retrospective review of 64 children treated with external fixation for lower limb long bone fractures between 1982 and 1998.
- Follow-up data was available for 44 children (46 fractures), with an average follow-up duration of 4 years.
- External fixators were in place for an average of 67 days.
Main Results:
- Full range of movement was achieved in 42 children (44 limbs).
- Anatomical alignment (less than 5 degrees angulation) was maintained in 40 children (42 limbs).
- Minor complications included one case requiring tibial osteotomy for malalignment and two cases of significant leg length discrepancy (>2 cm).
Conclusions:
- External fixation is a straightforward, rapid technique with a minimal learning curve for pediatric long bone fractures.
- It is particularly well-suited for comminuted, closed fractures and for pediatric patients experiencing polytrauma.
Abstract:
The use of external fixation in the immobilization of diaphyseal and metaphyseal fractures in children is still controversial, as these fractures are generally managed by immediate plaster casting, by traction followed by casting, by various methods of internal fixation, including the recently developed flexible rods, and by plating. Between 1982 and 1998, we treated 64 children with fractures of the long bones of the lower limb using external fixation, 44 of whom were available for follow-up (46 fractures). Their average age on the day of injury was 8.l years. Average follow-up extended for 4 years. The external fixation used was left in place for an average of 67 days. Full range of movement was achieved in 42 children (44 limbs). The longitudinal axis was anatomically correct (<5 degrees angulation) in 40 children (42 limbs). Due to malalignment of the fracture (15 degrees varus) in one child, tibial osteotomy was performed 4 years after fracture healing. There was no leg length discrepancy in 38 children, and shortening of >2 cm was measured in the fractured limbs of 2 children. We found the use of external fixators to be easy, quick, with a short learning curve, and appropriate for comminuted and closed fractures of the long bones, and especially for children with polytrauma.
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