[Late results following shaft fractures of the lower extremities in the growth period].

Abstract

In a retrospective study 275 femoral-shaft fractures and 652 tibial respectively fibular fractures of the growing skeleton were evaluated. A posttraumatic limb length difference was present in 70% after femoral fractures and in 40% following fractures of the lower leg. In the control group of 822 examined persons we found an idiopathic difference of the length of the limb in 25%. Following femoral fractures the limb length difference was in average 10 mm. However following fractures of the tibia and fibula it was 7 mm. There is no evidence that an established difference in length will improve in course of growth. Factors influencing the alteration of length are discussed. It could be shown that there is no primary therapeutic way of influencing the alteration of length and that the so called prophylactic "shortening" at time of consolidation cannot prevent future lengthening. Also we could prove that rotational deformities of the femur show a good prognosis regarding spontaneous correction. Deformities of the lower leg however do not show spontaneous correction and ought to be corrected primarily. The incidence and degree of future alteration of length of the lower limb can only be influenced indirectly by early definite stabilisation of the fracture without leaving an axial deformity behind. For stable non-dislocated fractures the plaster of cast treatment is sufficient. However for unstable, dislocated (displaced) fractures which need anaesthesia for primary treatment, the unilateral external fixator is proposed as the method of treatment. Functional follow up examinations to evaluate possible posttraumatic alteration of the length of the lower limb, have to be performed at least for two years after the accident.