Application of a self-designed external fixation restorer for femoral shaft fractures in children

Abstract

Objective To evaluate a self-designed external fixation restorer used for femoral shaft fractures in children. Methods From September 2016 to October 2017, 19 children were treated at Department of Pediatric Orthopaedics, The Third Hospital of Hebei Medical University for irreducible femoral shaft fractures using our self-designed external fixation restorer. They were 15 males and 4 females, aged from 4 years and 2 months to 8 years (average, 6.3 years). There were 7 transverse fractures, 11 short oblique fractures and one oblique fracture. The restorer was applied directly to the femur for traction and temporary external fixation. The femoral shaft fractures were reduced closely before internal fixation with elastic stable intramedullary nails. The Flynn criteria for lower limb fracture were used to evaluate the curative effects postoperatively. Results The operative time ranged from 32 to 45 minutes (37 minutes on average). All the fractures obtained closed reduction. No such intraoperative complications occurred as traction and compression injury to soft tissues like muscle, nerve and blood vessel. Follow-ups ranged from 8 to 20 months (average, 13 months). All the fractures got united after 7 to 15 weeks (average, 10.1 weeks). No implant failure or breakage occurred. The implants were removed 6 to 8 months after operation when the fractures got united. According to the Flynn evaluation criteria at the last follow-up, 18 cases were excellent and one was good. Conclusions Due to its advantages of simplicity, easy manipulation and direct action on the femur for traction, our self-designed external fixation restorer can improve the closed reduction for femoral shaft fractures in children so that its sustained and effective traction force and high quality of fracture closure avoid surgical opening. The temporarily fixation it provides after fracture reduction can facilitate intraoperative fluoroscopy of the femur. Key words: Femoral fractures; Fracture fixation, internal; Bone nails; Children; Fixation restorer