Early complications with external fixation of pediatric femoral shaft fractures

A retrospective study of 27 pediatric patients with femoral shaft fractures treated by external fixation was made to identify complications and evaluate outcomes. The average age at the time of injury was 8 years, 9 months (range 5 years, 6 months to 13 years, 2 months). Sixteen fractures were isolated, and nine were associated with polytrauma. There was only one open fracture. Data obtained from chart review (n = 27), radiographs (n = 27), physical exam (n = 16), and questionnaire (n = 21) identified eight major complications (30%) in six patients and 29 minor complications (107%) in 20 patients. The major complications included two refractures, two fractures through pin sites, one postimmobilization supracondylar femoral fracture, one persistent pin-tract infection requiring early fixator removal, one malreduction, and one loss of reduction. Both the patient with malreduction and the one who lost reduction had >10 degrees of varus deformity before adjustment of their frames. Five of the eight major complications (64%) were secondary to errors in operative technique or postoperative treatment. Only one major complication was noted among the 16 patients with isolated injuries. Of the patients with minor complications, 14 had pin-tract infections requiring oral antibiotics, five refused to go to school with the fixator in place, five were dissatisfied with scar appearance, and five had clinically insignificant malunions. A clinically insignificant malunion was considered to be angulation greater than or equal to 5 degrees varus or valgus or greater than or equal to 10 degrees procurvatum or recurvatum deformity that did not affect the patient's function. The minor complications were considered intrinsic to the procedure and difficult to avoid. Despite these problems, all patients with isolated injuries, except one with a slipped capital femoral epiphysis, had excellent function at the time of final review. If external fixation is chosen as the method of treatment for a pediatric femur fracture, careful attention must be paid to operative technique and postoperative treatment in order to minimize complications.