External skeletal fixation in children's fractures

Fourteen children with acute fractures, mostly open fractures, were treated with Hoffmann external fixation as a part of their fracture care. Thirteen fractures involved the tibia and one the femur. The average follow-up of these children was 17 months. The Hoffmann device was used for 6 to 20 weeks with an average of 11 weeks. One-half of the children had purulent drainage at some time during their treatment although no chronic infections resulted. Fracture union was present after 12 to 52 weeks with a median of 17 weeks. Three refractures occurred after apparent union. The only final angular deformity was in one patient with 6 degrees of varus. Three patients had leg length discrepancies of 2 cm or more. Four patients had overgrowth of the injured limb of 1.0 to 3.0 cm. Range of motion was not permanently impaired by the Hoffmann device. Use of the Hoffmann device for external skeletal fixation is recommended in children with open fractures with skin loss or burns, in children with head injury with resultant increased motor tone, and in polytrauma patients to facilitate patient care and transport for diagnostic and therapeutic procedures.