Pattern, treatment modalities and radiological outcome of pediatric femoral shaft fractures; fractures treated in Northern, Tanzania

Abstract

Background: Femoral shaft fracture is among the most common causes of paediatric hospitalisation, mortality and morbidity worldwide. There is no clear option that is preferable to other treatment modalities, especially between 5 to 16 years and published studies are scarce on radiological outcomes in Sub-Saharan Africa.This study aimed to determine the pattern, treatment modalities and radiological outcome of the paediatric femoral fractures treated at KCMC. Methodology: A cross-sectional study was conducted for all children with femoral shaft fractures treated at Kilimanjaro Christian Medical Centre from 1st January 2018 to 31st December 2022. The approval to conduct the research was obtained from Kilimanjaro College Research Ethics and Review Committee(CRERC) with ethical clearance Reg NO PG 88/2022. In our study we used secondary data and the permission to conduct the research was obtained from KCMC, hence no formal consent was required from patients/parents. The patient’s information was traced through patient files and the hospital's electronic system. The radiological outcome; shortening, angulations in six weeks and fracture union, 12 weeks post-management were reviewed with the involvement of a consultant radiologist and the orthopaedic surgeon to obtain the precise information and were recorded on the extraction sheet. Results: This study included 230 study participants who met the inclusion criteria. The mean age of participants was 9.1 (5.1) years, 41.3%, was aged 6 – 12 years, 82.2% were males, 45.7% were involved in a MTC, and 83.5% had no health insurance. The commonest fracture type was 92.6% closed, 48.7% transverse, and 65.% right side. Non-operatively was used in 50.9% of which 76.8% were treated with late hip Spica. Of those treated operatively, 61.1% were plating. The majority had good radiological outcomes with acceptable solid union, angulation and shortening. Those patients who were not operated had 94% lower odds of satisfactory radiological outcomes than those who were operated ( AOR=0.06, 95% CI: 0.01 – 0.27 and p<0.001) whereas other factors were not statistically significant. Conclusion: The majority of the study participants were male and were involved in MTC as the commonest mechanism of injury. Most had closed fractures that mainly presented on the right side and transverse fractures were the most common type. The hip Spica was common non-operatively option; however, plating was the most common operative option. Treatment modality substantially affected radiological outcomes and was statistically significant.