External fixation of femoral shaft fractures in children: Enhanced stability with the use of an auxiliary pin

From 1989 through 1994, we used a monolateral external fixator (Orthofix) t o treat 39 femur fractures in 37 patients. The average age of the patients was 9.5 years (range, 5+11 to 18+8 years); 38 fractures were closed, and on e was a grade I(Gustillo-Anderson classification) open fracture. Twenty-two fractures were treated by using the standard Orthofix pin configuration wi th two or three pins held in the pin clamps both above and below the fractu re. We treated the remaining 16 fractures identically, except for the addit ion of an auxiliary pin, which was secured to the body of the fixator by us ing wire and methylmethacrylate. All patients were followed up to union and fixator removal at a mean of 97 days after fixator placement (range, 50-17 5 days). Thirty-one (84%) patients were followed up for 1 year after injury . Six of 22 femurs without an auxiliary pin required remanipulation for los s of reduction. Only one of 16 femurs treated with an auxiliary pin require d remanipulation. Four of 22 femurs without an auxiliary pin went on to mal union. No femur with an auxiliary pin went on to malunion.