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[Management of unstable shaft fractures of the lower extremity in children using the external fixator]
Insights
External fixation is an effective treatment for unstable pediatric tibial and femoral shaft fractures, enabling early weight-bearing and shorter hospital stays compared to traditional traction methods.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
Context:
- Unstable tibial and femoral shaft fractures are common in children.
- Traditional traction methods result in prolonged hospitalization and potential deformities.
Purpose:
- To evaluate the efficacy of external fixation for treating unstable pediatric tibial and femoral shaft fractures.
- To compare external fixation with traditional traction methods.
Summary:
- This study treated 31 unstable tibial and femoral shaft fractures in 30 children (ages 2-15) using the Howmedica monotube-fixator system.
- The system features self-drilling screws and simple dynamization, allowing closed reduction under X-ray control.
- External fixation facilitated early weight-bearing mobilization and reduced hospital stay, with patients walking fully weight-bearing one day post-treatment.
Impact:
- External fixation offers a superior treatment option for pediatric unstable lower extremity fractures.
- This method leads to shorter hospital stays, earlier mobilization, and quicker return to the child's environment.
- Advantages outweigh disadvantages such as pin tract infections and need for anesthesia for removal.
Method:
Since 1993 we have treated 30 children between 2 and 15 years with 31 unstable tibial and femoral shaft fractures. We perform closed reduction und X-ray control and stabilize the fracture using the monotube-fixator, system Howmedica. The advantages of this system are based on the self-drilling, self-cutting screws and the simple dynamization.
Discussion:
The treatment of dislocated, instable fractures of the tibial and femoral shaft in children using traction method is related with a long hospital stay in an uncomfortable position. The traction method leads to bone healing, but with a high rate of deformity after reposition. We treat the shaft fractures of the lower extremity using the external fixation. This method allows to reach early weight bearing mobilisation, it is related to a shorter hospital stay. The child is already one day after initial treatment allowed to walk with full weight bearing. The treatment with the external fixation is a modification of the traction method.
Conclusion:
We think to have a good concept of treatment using external fixation in children with unstable fractures of the femur and tibia shaft. The disadvantages namely pin tract infections, general anesthesia for removal and difficulties with the reduction are overruled by the advantages as short hospital stay, early weight bearing mobilisation and early return of the child to his own environment.