[Pediatric femoral shaft fracture in the 6-14 year age group. A retrospective therapy comparison between conservative treatment, plate osteosynthesis and external stabilization].

The optimal choice between operative and conservative therapy in the treatment of femur shaft fractures in school age children remains controversial. Between 1985 and 1991, 34 children aged 6-14 years were treated in our institution for fractures of the femoral shaft: 8 were treated conservatively with traction, while 10 underwent plate fixation and 15 external fixation. The 34 cases were analyzed retrospectively. In the conservatively treated group a plate osteosynthesis become necessary in 2 patients because of delayed union and fracture malalignment. Hospitalization was the longest in these children, although their concomitant injuries were the least extensive. In the group with plating there were no serious complications but open surgery is needed for two major operations for insertion and removal. The average time on crutches after plate fixation was 56 days. In the group treated by external fixation four secondary plate osteosyntheses were performed, two at an early stage because of unacceptable fracture malalignment and two others because of fracture instability after removal of the fixateur. The stay in hospital was the shortest in this group. The 11 children who had been completely managed by external fixation achieved walking without crutches in the shortest time, viz. 15 days after the operation on average. The average time to removal of the fixateur was 67 days. Review was possible in 27 of the 28 children who had been completely managed by the initial treatment method. All had unlimited hip and knee motion. Two children in the conservative treatment group were seen on radiographical examination to have a varus angulation of more than 10 degrees. In the plate and fixator group no malalignment was present.(ABSTRACT TRUNCATED AT 250 WORDS)