Management of Paediatric Femoral Shaft Fracture by Surface Traction and Thigh Brace Immobilization

Background: Management of paediatric femoral shaft fracture by surface traction and thigh brace immobilization is a very easy way to treat paediatric femoral shaft fracture in pre school age. Femoral shaft fractures are one of the most common major pediatric injuries managed by the orthopedic surgeons. Management is influenced by associated injuries or multiple traumas, fracture personality, age, family issues and cost. In addition,child abuse should be considered in a young child with femoral fracture. Nonsurgical management,usually with early spica cast application is preferred in younger children. Surgery is common for the school going age child and for patients with high energy trauma. In the older child,traction followed by casting,external fixation, flexible intramedullary nails and plate fixation have specific indications. Skeletally mature teenagers are treated with rigid intramedullary fixation.Potential complications of treatment include shortening,angular and rotational deformity, delayed union,non union,compartment syndrome, over growth,infection,skin problems and scarring. Risk of surgical management includes refracture and external fixator or plate removal, osteonecrosis after rigid antegrades intramedullary nail fixationand soft tissue irritation caused by the ends of flexible nails.
Objective: To evaluate the outcome of traction and bracing in pediatric femoral shaft fracture.
Methods: In our study we have selected the pre school age (1 to 5 years). Naturally bone heals early in this age and surgery is rarely required. Usually orthopedic surgeons apply surface traction for 3 to 4 weeks followed by hip spica for another 6 to 8 weeks. But this is very difficult to maintain and annoying for both the patients and their parents. In our study, we have applied surface traction for 3 to 4 weeks followed by thigh brace immobilization for another 3 to 4 weeks. After that patients were allowed to walk with support. Patients were advised to follow up at 2,4,8 and 12 weeks with x-rays. They were encouraged to bear weight in the fractured limb. Brace was removed after achieving radiological union.
Result: Out of 14 patients, 2 patients missed follow up, remaining 12 patients were found excellent.
Conclusion: This is a very easier, cheap and comfortable way to manage paediatric femoral shaft fracture specially in pre school age which can be applied from the higher centre to the root level of our health service with very minimum to no complication.