Femur Fractures in Pediatric Neuromuscular Patients: Understanding Complications in a High-Risk Population

Managing femur fractures in pediatric patients with neuromuscular (NM) disease poses challenges due to joint contractures, spasticity, and low bone density, with fractures often occurring from minimal trauma. Treatment decisions entail navigating multiple potential complications. This study aimed to evaluate treatment outcomes of patients with NM disease who sustained femur fractures.

A retrospective analysis of 139 femur fractures in 106 pediatric NM patients over a 10-year period was conducted. Radiographic, clinical, demographic, and treatment data were collected. Malunion criteria included >2 cm shortening, frontal plane angulation >10 degrees, or sagittal plane angulation >30 degrees. Patients with insufficient follow-up were excluded.

The majority of patients were treated conservatively (65% of femurs). The overall complication rate was 59.3% in the conservatively treated group and 62.5% in the surgically treated group. The most common complication observed was malunion (38%). Fifty-eight patients had more than one fracture, 95% being wheelchair users. Nonambulatory status, prior femoral surgery, spasticity, and anticonvulsant use were potential contributors to fracture risk and complications.

Conservative versus surgical treatment of pediatric femur fractures in NM patients have similar complication rates. Surgical management was noted to have a lower rate of malunion but a higher risk of skin or wound complication, refracture, and unplanned return to the OR. Further studies are needed to assess how patients are affected by malunion to inform shared decision-making in this complex population.

Level IV.