Devinder Singh Gulati, Anoop Kumar
BACKGROUND Shaft of femur is third most common location of fractures among children. In children there is strong potential for early union and remodeling even with conservative treatment. Conservative treatment is an accepted and good option while treating fracture shaft of femur in children under 10 years of age. Main complication of femoral shaft fracture is a possible leg length discrepancy and angulation resulting from initial overriding of bone fragments and from the overgrowth phenomenon in the fractured limb. MATERIALS AND METHODS In the present study 50 children were treated conservatively for fracture of shaft of femur between May 1993 to December 1993 (one year) at Department of Orthopaedics, Government Medical College, Jammu. All children were treated conservatively by skin traction for a mean period of 14 days followed by hip spica cast for further 28 days, there-after mobilization in functional brace. The mean follow-up was 5 years. At last follow up, mean age was 10 years and 7 patients attained skeletal maturity (7%). RESULTS Results were accessed after reviewing records of 50 children under study. At the last follow-up, the fractured limb was shorter than the normal limb, 1.5 mm on average, based on measurements of the femoro-tibial Skelton and 3.5 mm on average, based on, level of the femoral heads, while radiograph taken with patient in the standing position. The major part of this shortening was due to fractured femur (2.1 mm on average). The mean femoral overgrowth was 9.6 mm and then mean tibial outgrowth was 0.6 mm. CONCLUSION All children were respectively reviewed clinico-radiologically and results were analysed. In this study, a positive correlation was found between amount of initial fragment overlap and the overgrowth phenomenon. While comparing final limb length discrepancy with initial overlap, 9.3 mm overlap was found to be tolerated to avoid significant limb length discrepancy.
