Conservative Treatment of Shaft Femoral Fracture in Children Between Ages (12-48) Months

Abstract

Back ground and Objective: Spica cast is an effective method for treatment of closed femoral shaft fracture in young children.

Aim of the study: Study done to compare between early (1-4)days, and delayed spica cast treatment after traction 2-3 weeks as a definitive treatment to see any difference in terms of results and complications, their advantages, 1imitation of acceptable reduction, overgrowth Phenomenon, period of hospitalization and cost.

Patients and Methods: This study done in our teaching Hospital, Thirty eight patients closed femoral shaft fracture were included in our study their age range between (12-48) months, Antero posterior and lateral views of the injured femur were taken as well as x-ray of pelvis. In 22 patients, early spica cast was done in the first (1-4) days after admission to the hospital. 16 patients continue on skin traction (2-3) weeks, when the fracture feels sticky and early callus appear on the x-ray one and half a hip spica is done under general anesthesia under guide of x-ray screening.

Results: The mean age was 30 months, the sex distribution of the patients was 23males 61%, 15 females 39%. 22 cases, right sided fractures 58%, while left sided fractures in 16 children 42%. The causes of fracture femur in our study were 24cases (63%) for fall on the ground, 8cases (21%) by fall from height and lastly 6 cases (16%) by road traffic accident. The sites of fracture shaft femur in children, according to which third of the femur is affected were20 cases 52%in the middle third,12 cases 31% for the proximal third, and 6cases 17% in the distal third. Initial observation of  complications in our patients immediately after removal of the spica in patients treated with early spica  were 2 cases for shortening, while patients treated with delayed spica following skin traction only one cases. Regrinding lateral angulations only one cases. Recorded in early type of spica.

Conclusions: Fracture shaft femur in children treated by early spica cast or delayed spica cast proved to obtain good results in spite of the presence of some degrees of shortening or angulations'. Which prove to be limited at the end of follow up. In decreasing hospitalization time, thus the parents and the patients will be more obedient.