Platz A, Käch K
Chirurgische Klinik, Kantonsspital Winterthur.
Swiss Surg. 1996;2(6):284-9.
Since 1993 we have treated 30 children between 2 and 15 years with 31 unstable tibial and femoral shaft fractures. We perform closed reduction und X-ray control and stabilize the fracture using the monotube-fixator, system Howmedica. The advantages of this system are based on the self-drilling, self-cutting screws and the simple dynamization.
The treatment of dislocated, instable fractures of the tibial and femoral shaft in children using traction method is related with a long hospital stay in an uncomfortable position. The traction method leads to bone healing, but with a high rate of deformity after reposition. We treat the shaft fractures of the lower extremity using the external fixation. This method allows to reach early weight bearing mobilisation, it is related to a shorter hospital stay. The child is already one day after initial treatment allowed to walk with full weight bearing. The treatment with the external fixation is a modification of the traction method.
We think to have a good concept of treatment using external fixation in children with unstable fractures of the femur and tibia shaft. The disadvantages namely pin tract infections, general anesthesia for removal and difficulties with the reduction are overruled by the advantages as short hospital stay, early weight bearing mobilisation and early return of the child to his own environment.
自1993年以来，我们对30例2至15岁的儿童治疗了31例不稳定的胫骨干和股骨干骨折。我们进行闭合复位并通过X线控制，使用豪美迪克（Howmedica）单管固定器系统固定骨折。该系统的优点基于自钻、自切螺钉以及简单的动力化操作。
采用牵引方法治疗儿童胫骨干和股骨干脱位、不稳定骨折，住院时间长且体位不适。牵引方法可实现骨折愈合，但复位后畸形率高。我们采用外固定治疗下肢骨干骨折。该方法可早期负重活动，住院时间较短。患儿在初始治疗一天后即可完全负重行走。外固定治疗是对牵引方法的改进。
我们认为对于儿童股骨和胫骨干不稳定骨折采用外固定治疗有一个良好的治疗理念。诸如针道感染、拆除时需全身麻醉以及复位困难等缺点，被住院时间短、早期负重活动以及患儿早日回归自身环境等优点所抵消。
