LEG LENGTH INEQUALITY FOLLOWING PEDIATRIC FEMORAL FRACTURES - FINAL OR TEMPORARY PHENOMENON

Leg length inequality is the most common complication reported after f emoral shaft fractures in childhood. Most authors agree that significa nt overgrowth occurs in the first two years after injury and will not be further corrected. We reviewed 221 patients (166 boys, 44 girls) wi th a fracture of the femoral shaft. The mean age at the time of fractu re was 6.5 years (range 11 months to 12 years); 123 patients were trea ted conservatively, 96 by skin traction, 11 by skeletal traction, and 16 by immediate cast bracing. In 98 patients the fracture was stabiliz ed by osteosynthesis. In 5 fractures located in the distal third of th e femur we used crossed Kirschner wires. Fifty-nine patients were trea ted by intramedullary nailing, without problems regarding trochanteric apophyseal arrest or alteration in the collum angle. Thirty-four pati ents were treated by plate fixation, this being associated with high r ates (9%) of Implant-breakage. A total of 127 patients were interviewe d and examined; they were skeletally mature at the time of reexaminati on. A leg-length discrepancy was found in 45 patients. Shortening from 10 to 30 mm (mean 14.3 mm) occurred in 7 patients; 38 patients had le ngthening from 10 to 25 mm (mean 14.1 mm). Overgrowth significantly de pended on the age at trauma (4-9 years; P=0.04), number of repositions (2 or more; P=0.0005) and degree of axial deviation (>10 degrees; P=0 .04). Delayed surgical treatment (>48 h; P=0.0035), especially plate f ixation (P=0.0003)induced overgrowth as well. Forty-six patients had p revously been reevaluated 12 years before (1981). In 12 patients 13 ye ars or older at the time of the first review, no change in leg-length difference occurred. At the first review 34 patients were younger than 13 years. Eight of them had no leg-length discrepancy. In 16 patients the growth rate of the affected femur decreased, so that leg-length d iscrepancy diminished after the 2-year period post-traumatically in a range from 5 to 15 mm. Overgrowth of the femur continued in 7 cases ra nging from 5 to 10 mm. No change occurred in 3 patients. Thus, there i s a further change in length inequality more than 2 years post-traumat ically.