POSTTRAUMATIC LIMB SHORTENING AFTER CONSE RVATIVE AND OPERATIVE TREATMENT IN DIAPHYSEAL FEMORAL FRACTURES IN CHILDREN

Between 1986 and 1991, 120 femoral fractures were treated in 116 child ren. The treatment of choice was conservative in young patients (overh ead traction in 1- to 3-year-old children, Weber traction in 3- to 8-y ear-old children). Operative treatment was indicated in older children : plate fixation was performed in children between 5 and 16 years of a ge, while external fixation was used in children aged 2-14 years. In a retrospective study 66 femoral fractures in 62 children were reviewed and limb length checked both clinically and by ultrasound measurement . For ultrasound evaluation a special device was constructed to provid e standardized measuring conditions. In 27 cases we observed specific complications related to the method. In all cases fracture healing occ urred, but in 7 cases it was necessary to change the method of treatme nt. Ultrasound measurement revealed mean limb lengthening of 5.5 mm af ter overhead traction (max. 11 mm) and of 7 mm (max. 25 mm) after Webe r traction. The median difference in leg length after operative treatm ent was 5.5 mm (max. 15 mm) for plate fixation and 8.5 mm (max. 25 mm) for external fixation. Our results allow no definitive statement on t he most suitable treatment for femoral fractures in children (conserva tive versus operative treatment), except that children under 3 years o f age are best treated by overhead traction.