[Rotational deformities following pediatric femoral shaft fracture]

At the beginning of 1983 65 children who had been treated at our hospital for fractures of the femoral shaft could be followed-up both clinically and radiologically at an average of 29 months after the injury. The radiological examination was performed with special regard to the rotational deformity; the torsion was measured using Rippstein's method. Out of 65 patients, 19 patients showed a difference between the angles of antetorsion of more than 10 degrees (29.2%) which we considered to be "rotational malpositions" (8 patients with endorotational and 11 patients with exorotational deformities). 40% of all fractures localized in the proximal third of the femur were accompanied by a rotational deformity of more than 10 degrees as compared to the other side. Exactly 4 years later a second examination of antetorsion was made using the same methodical procedure. 18 out of the 19 patients with rotational malpositions and 2 patients with a difference between the AT-angles of exactly 10 degrees could be re-examined. The average correction in the overall population was 3.4 degrees (-10 degrees to +5 degrees). In 15 cases we found a decrease in the difference between the angles of antetorsion by 5.8 degrees on an average, 1 patient showed no change in the difference, and in 4 patients the difference had increased by 3 degrees on an average. In 7 of the 20 patients (35%) the difference between the angles of antetorsion was less than 10 degrees, whereas the rotational malposition persisted in 13 cases. The extent of correction was much larger in patients with exorotational deformities than in those with endorotational deformities. A very close relation could be seen between the age of the children and the extent of correction. Furthermore, rotational deformities caused by fractures of the proximal third of the femoral shaft showed significantly less tendency towards correction than fractures with a more distal location.