EARLY COMPLICATIONS WITH EXTERNAL FIXATION OF PEDIATRIC FEMORAL-SHAFTFRACTURES

A retrospective study of 27 pediatric patients with femoral shaft frac tures treated by external fixation was made to identify complications and evaluate outcomes. The average age at the time of injury was 8 yea rs, 9 months (range 5 years, 6 months to 13 years, 2 months). Sixteen fractures were isolated, and nine were associated with polytrauma. The re was only one open fracture. Data obtained from chart review (n = 27 ), radiographs (n = 27), physical exam (n = 16), and questionnaire (n = 21) identified eight major complications (30%) in six patients and 2 9 minor complications (107%) in 20 patients. The major complications i ncluded two refractures, two fractures through pin sites, one postimmo bilization supracondylar femoral fracture, one persistent pin-tract in fection requiring early fixator removal, one malreduction, and one los s of reduction. Both the patient with malreduction and the one who los t reduction had >10 degrees of varus deformity before adjustment of th eir frames. Five of the eight major complications (64%) were secondary to errors in operative technique or postoperative treatment. Only one major complication was noted among the 16 patients with isolated inju ries. Of the patients with minor complications, 14 had pin-tract infec tions requiring oral antibiotics, five refused to go to school with th e fixator in place, five were dissatisfied with scar appearance, and f ive had clinically insignificant malunions. A clinically insignificant malunion was considered to be angulation greater than or equal to 5 d egrees varus or valgus or greater than or equal to 10 degrees procurva tum or recurvatum deformity that did not affect the patient's function . The minor complications were considered intrinsic to the procedure a nd difficult to avoid. Despite these problems, all patients with isola ted injuries, except one with a slipped capital femoral epiphysis, had excellent function at the time of final review. If external fixation is chosen as the method of treatment for a pediatric femur fracture, c areful attention must be paid to operative technique and postoperative treatment in order to minimize complications.