Comparative Study Of Two Treatments For Children Femoral Shaft Fractures

Objective Random group, to compare early spica casting and traction with delayed spica casting for children age from one to five years. Discuss the mutual relationship of fracture type, location and shortening deformity, angular deformity and overgrowth.Methods Between December 2008 and May 2010, a total of 72 children with femoral shaft fractures were treated with spica casting,5 cases excluded,67 patients in study. Experimental design according to the principle of completely random, in accordance with the treatment order, according to the parity of the random number, divided children into A, B groups. Traction with delayed spica casting in A group, a total of 32 cases; early spica casting in B group, a total of 35 cases. Children taken for follow up and X-ray.1 year after injure is the end of the observation, recording the incidence of complications, using ASK scoring system for evaluation. Statistical analyse the follow up results.Results 58 children were followed up, mean follow up 17 months (11～21 months), all fractures were healed.3 patients replace spica casting due to fracture of spica casting. Because of excessively tight of spica casting,5 patients replace spica casting under anesthesia, all of them aged less than 14 months.9 cases occurred perineum rash with skin traction, in which the boy in 1 case, the girl in 8 cases. All cases were no serious pressure sore. Traction time of A group was 19 days (11 days～23 days), B group<2 days. Fixed time of A group was 25 days(2～31 days), B group was 46 days(42～56 days). Fracture healing time of was 44 days(41～54 days), B group was 46 days (42～56 days), P> 0.05. Hospital costs of A group was 7,845 yuan (6433～8749 yuan), B group was 4,924 yuan (3987～6132 yuan). Hospitalization time of A group was 16 days(12～25 days), B group was 3 days (1～4 days).Children with ASK scores, A group was 97 points (82～100 points), B group was 91 points (81～100 points), no significant difference in the two groups; earlier functional recovery in early spica casting,31% of the children can crawl after 3 days of injure,70% of the patients can standing after 4 weeks, more satisfied parents. Femoral overgrowth of A group was 11mm(5～16mm), femoral overgrowth of B group was 9mm (4-19mm), P> 0.05. Logistic regression analyse the relationship of children age, fracture type, location, initial shortening and angular deformity, shortening deformity, overgrowth:upper femoral shaft fractures and early spica casting are factors of angular deformity, with no relationship of the middle, distal fracture, fracture type and age; transverse fracture is the most risk factors of shortening deformity, no relationship with age, fracture type, spiral and oblique fractures, initial shortening; skin traction with delayed spica casting, initial shortening, spiral and oblique fracture type are the factors of overgrowth.Conclusion 1. Traction with delayed single-leg spica casting and early single-leg spica casting are effective methods for children age from one to five years, no fracture nonunion and malunion.2. Initial shortening of femoral fractures and overgrowth are positively correlated, overgrowth is more apparent in oblique and spiral fracture.3. Early single-leg spica casting, children can crawl, stand or walk, conducive to functional recovery, and facilitate the care of perineum skin, reduce or avoid the occurrence of perineum rash. However, for transverse and upper femoral shaft fractures, re-displacement (shortening and angulation) are more common, skin traction with delayed single-leg spica casting should be adoption.4. Earlier functional recovery in early single-leg spica casting than traction with delayed single-leg spica casting.5. Single-leg spica casting, without excessive knee flexion, to avoid the occurrence of compartment syndrome.6. Compare against traction with delayed single-leg spica casting, early single-leg spica casting has less overall cost and shorter hospitalization time, earlier recovery of children to family life, parents can return to work as soon as possible, reduce the burden of care for children,has a positive social meaning.