PLATE FIXATION OF FEMORAL-SHAFT FRACTURES IN MULTIPLE INJURED CHILDREN

A study was done of twelve patients (seven boys and five girls) who, b ecause of multiple injuries or a head injury, had been managed with co mpression plating of a unilateral or bilateral femoral-shaft fracture at a level-I trauma center from 1986 through 1990. The patients had a total of fifteen fractures. The average age at the time of the injurie s was eight years (range, five years to nine years and eleven months). There were nine closed fractures and six open fractures; three of the open fractures were Grade I; two, Grade II; and one, Grade IIIA, acco rding to the criteria of Gustilo et al. Each patient had an average of three associated injuries. All fifteen fractures had healed clinicall y and radiographically at an average of eight weeks (range, six to twe lve weeks) after the operation. There were no infections. Anatomical a lignment was obtained in fourteen limbs. One fracture healed with 13 d egrees of anterior angulation. The compression plates were removed at an average of ten months (range, three to twenty-four months) after th e index operation. At the latest follow-up evaluation (average, twenty -six months; range, eleven to fifty-seven months), no patient had rest riction of activities due to the femoral fracture. Scanograms revealed overgrowth of the injured femur averaging 0.9 centimeter (range, 0.3 to 1.4 centimeters) in seven patients who had an uninjured contralater al femur. We believe that plate fixation of the femur is a good treatm ent option for children who have a femoral shaft fracture and a major head injury or multiple injuries, or both.