ISOLATED CLOSED DIAPHYSEAL FRACTURES OF THE FEMUR IN CHILDREN - COMPARISON OF EFFECTIVENESS AND COST OF SEVERAL TREATMENT METHODS

The effectiveness of several treatment modalities for isolated closed femur fractures in children ages 4 through 16 years is compared based on outcome (clinical results, morbidity, and parents' satisfaction) an d cost. Between 1986 and 1993, 30 patients were treated. Treatment met hods included immediate hip spica cast application, distal femoral ske letal traction pin to align the fracture followed by early hip spica c ast incorporating the pin (6th day), in-hospital traction, primary ext ernal fixation, and primary intramedullary nailing. Average follow up was 4.1 years. Overall results were excellent with minimal morbidity f or all treatment methods. Early application of hip spica cast with or without incorporation of the distal femoral traction pin required the fewest hospital days, the shortest time to union, and had the lowest o verall cost. Complications, mainly malunion and femoral length discrep ancy, however, were greater. Skeletal traction resulted in,the longest hospital stay and was equal in cost to external fixation and intramed ullary nailing. Primary external fixation appears most applicable in p atients who are unlikely to tolerate early casting and who are at incr eased risk of avascular necrosis with femoral nailing. Patients treate d with an intramedullary nail had the fewest complications. Age, size, and gender of patient, location and type of fracture, as well as soci al circumstances are all significant factors in choosing the optimal m ethod of treatment.