Frech-Dörfler M, Hasler C C, Häcker F-M
University Children's Hospital, Pediatric Surgery, Römergasse 8, Basel, Switzerland.
Eur J Pediatr Surg. 2010 Jan;20(1):18-23. doi: 10.1055/s-0029-1241177. Epub 2009 Oct 28.
Despite the increasing use of flexible intramedullary nailing for the treatment of femoral shaft fractures during growth, the use of acute or delayed plaster fixation is still a widely practised alternative in preschool children. The purpose of this retrospective study was to analyse outcome following acute casting in preschool children with a focus on acceptable initial leg length discrepancy and angulation.
A retrospective study was performed of 46 children with femoral shaft fractures treated conservatively. It was possible to verify the outcome in 22 children with an average follow-up time of 7.5 years. We compared initial shortening and mal-angulation to radiographic data at the time of consolidation and clinical outcome.
Most children sustained their fracture by falling out of bed or from their parent's arm. A hip spica including the foot of the injured side, a pelvic ring and the thigh of the uninjured leg was applied under sedation and manual traction. Mean time of hospital stay was 1.4 days (range, 2 h-20 days). The average immobilisation time was 16.7 days (range, 0-30 days). At follow-up, on average 7.5 years after trauma, only one patient showed a leg length discrepancy greater than 2 cm. One patient showed a minor valgus and rotational deformity.
The long-term outcome for conservatively treated femoral shaft fractures in preschool children is very good, even in severely dislocated fractures. Our data show that even initial shortening of up to 2.5 cm can be treated successfully with a spica cast.
尽管在儿童生长期间，弹性髓内钉治疗股骨干骨折的应用日益增多，但在学龄前儿童中，急性或延迟石膏固定仍是一种广泛应用的替代方法。本回顾性研究的目的是分析学龄前儿童急性石膏固定后的结果，重点关注可接受的初始腿长差异和成角情况。
对46例采用保守治疗的股骨干骨折患儿进行回顾性研究。对22例患儿进行了结果验证，平均随访时间为7.5年。我们将初始缩短和成角情况与骨折愈合时的影像学数据及临床结果进行了比较。
大多数患儿是因从床上跌落或从父母怀中掉落而骨折。在镇静和手法牵引下，应用包括患侧足部、骨盆环和健侧大腿的髋人字石膏。平均住院时间为1.4天（范围：2小时至20天）。平均固定时间为16.7天（范围：0至30天）。随访时，平均在受伤7.5年后，只有1例患儿的腿长差异大于2 cm。1例患儿出现轻度外翻和旋转畸形。
学龄前儿童股骨干骨折保守治疗的长期效果非常好，即使是严重移位的骨折。我们的数据表明，即使初始缩短达2.5 cm，采用髋人字石膏也可成功治疗。
