Remodeling of angulation deformities in diaphyseal femoral fracture in children

• Published in: Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2012-11, Vol.17 (6), p.763-769
• Main Authors: Kamegaya, Makoto, Saisu, Takashi, Segawa, Yuko, Kakizaki, Jun, Sakamoto, Yuko, Hagiwara, Shigeo
• Format: Article
• Language: English
• Subjects: Age Factors; Body Weights and Measures; Bone Remodeling - physiology; Child; Child, Preschool; Cohort Studies; Diaphyses - injuries; Female; Femoral Fractures - diagnostic imaging; Femoral Fractures - physiopathology; Femoral Fractures - therapy; Fracture Healing - physiology; Fractures, Malunited - diagnostic imaging; Fractures, Malunited - etiology; Humans; Infant; Male; Medicine; Medicine & Public Health; Original Article; Orthopedics; Radiography; Rheumatology; Risk Factors
• ISSN: 0949-2658; 1436-2023
• DOI: 10.1007/s00776-012-0289-6

The purpose of this study was to reconsider the factors influencing the remodeling effects in diaphyseal femoral fractures in children based on radiological results. We reviewed 39 patients with more than a 5° residual angulation deformity at the fracture site on anteroposterior and/or lateral views at the primary healing stage. The average follow-up period was 30.4 months. Angulation deformity was measured on plain radiographs both at the primary healing stage and the final follow-up. The correction rate (A − B/A × 100, A angulation deformities at the primary healing, B the angulation at the final follow-up) between at the primary healing stage and final follow-up was analyzed in terms of age at injury (0−5, 6−9, and ≥10 years), fracture site (proximal one third, middle one third, and distal one third) and direction of the deformities (coronal and sagittal planes). The remodeling effect significantly appeared on the coronal plane (correction rate 66.7 %) rather than on the sagittal plane (correction rate 31.6 %) in the 0- to 5-year age group (P < 0.05). There was a statistically significant difference in the correction rate between the 0- to 5-year age group (66.7 %) and the 6- to 9-year group (30.6 %) on the coronal plane (P < 0.05), with no significance between any other two groups on both planes. No statistical difference of remodeling effect appeared among the three fracture sites. The average leg-length discrepancy was 4.7mm longer. We suggest that a patient ≤5 years at injury could expect more sufficient remodeling on the coronal plane compared with the other age groups on both planes. However, a patient >5 years at injury should be encouraged to undergo the maximum possible correction of the angulation deformity at the initial treatment. Surgical intervention might be considered for that purpose.