Simultaneous bilateral femoral fracture in children

Area of Science:

• Pediatric Orthopedics
• Trauma Surgery

Background:

• Bilateral femoral fractures in children (BFFC) are uncommon, with limited data on their occurrence and outcomes in low-resource healthcare settings.
• Understanding the management and results of BFFC in diverse environments is crucial for improving pediatric trauma care.

Purpose of the Study:

• To describe the experience and outcomes of managing bilateral femoral fractures in children (BFFC) at a level-1 pediatric facility in a low-income setting.
• To evaluate the effectiveness of non-operative management strategies for BFFC.

Main Methods:

• A 10-year retrospective study (2010-2020) of pediatric patients with bilateral femoral fractures (BFFC).
• Inclusion criteria required a bone-free disease diagnosis and a minimum 10-month follow-up period.
• Data collected included injury mechanisms, associated injuries, management methods (non-operative with spica cast or elastic intramedullary nails), and patient outcomes.

Main Results:

• Eight patients with ten bilateral femoral fractures (BFFC) were identified, predominantly affecting boys (7/8) with a median age of 8 years.
• Common injury mechanisms included road traffic accidents (4), falls from height (3), and being crushed (1). Associated injuries were frequent (6/8).
• All fractures healed with non-operative management (spica cast in 5, elastic intramedullary nails in 3). Excellent or good outcomes were achieved in 7 cases, with one instance of knee stiffness.

Conclusions:

• Non-operative management of bilateral femoral fractures in children (BFFC) can yield satisfactory healing and functional outcomes, even in low-resource settings.
• The study highlights the need for developing early surgical care options in low-income environments to potentially shorten hospital stays and facilitate earlier weight-bearing for pediatric patients with BFFC.