[Experience with external fixation in treatment of shaft fractures in childhood]

In a retrospective study 89 shaft fractures sustained during childhood and treated by external fixation were analysed [80 fractures of the lower extremity (59 of the femur) and 9 of the upper extremity]. The operative investment (operating time, period of hospitalization, time for fluoroscopy, general anaesthesia, start of mobilization, number of X-rays) correlated with the success of the treatment. The overall complication rate was 19.1%. Technical errors occurred in 5.6% of all cases; the infection rate was 4.5%; refractures were seen in 4.5% of all patients and reinfarction also in 4.5%. The last 10 femur fractures were analysed separately and the overall complication rate was demonstrably reduced to 3.2%. All technical errors are avoidable and the infection rate could be minimized by better care of the pin, exit points, and by ensuring more stable anchorage of the screws. The consolidation time is longer than with plate osteosynthesis and medullary nailing. But in contrast to adults, in children the treatment was completed with external fixation, and no pseudarthrosis was seen. The consolidation time was shorter with dynamic external fixation. With dynamic systems healing took an average of 7 weeks, while rigid systems needed an average of 9 weeks. Refractures and reinfarction were caused by the rigidity of the external fixation system. In isolated dislocated shaft fractures in childhood the advantages of the fixateur externe are its easy application, low level of invasiveness and early mobilization. It was used in all kinds of fractures in children aged 4-13 years.