Assessing leg length discrepancy following elastic stable intramedullary nailing for paediatric femoral diaphyseal fractures

Femoral overgrowth is a recognised phenomenon following fractures of the femoral diaphysis in children. This study was designed to assess leg length discrepancy (LLD) following elastic stable intramedullary nailing (ESIN) and its clinical significance. A retrospective review of children who underwen...

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Bibliographic Details
Published in:Archives of orthopaedic and trauma surgery 2007-07, Vol.127 (5), p.325-330
Main Authors: Mutimer, J, Hammett, R D, Eldridge, J D
Format: Article
Language:English
Subjects:
Adolescent
Anthropometry
Child
Child, Preschool
Diaphyses - injuries
Diaphyses - surgery
Female
Femoral Fractures - complications
Femoral Fractures - surgery
Follow-Up Studies
Fracture Fixation, Intramedullary
Humans
Leg Length Inequality - diagnosis
Leg Length Inequality - etiology
Length of Stay
Lower Extremity - anatomy & histology
Male
Retrospective Studies
Sensitivity and Specificity
Surveys and Questionnaires
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Summary:Femoral overgrowth is a recognised phenomenon following fractures of the femoral diaphysis in children. This study was designed to assess leg length discrepancy (LLD) following elastic stable intramedullary nailing (ESIN) and its clinical significance. A retrospective review of children who underwent ESIN with DePuy ACE Nancy nails between 1997 and 2001 for diaphyseal femoral fractures. Evaluation was by questionnaire, clinical examination and radiological measurement. 17/26 (65%) patients were followed up for a mean time of 48 months (21-77). Average age at surgery was 9 years. Mean operative time was 78 min with a mean hospital stay of 7.8 days. Mean time to union was 10 weeks. A statistically significant LLD of +3.2 mm is demonstrated in children aged 4-8 years (P = 0.05). LLD is not statistically significant in children over 8 years. ESIN is a successful treatment for paediatric diaphyseal femoral fractures and allows early mobilisation and discharge. A statistically significant LLD is observed in children aged 4-8 years although clinically only one patient in the entire series was aware of a leg length discrepancy. In addition clinical methods of leg length measurement are sensitive for LLD and we conclude that routine radiographic follow up is not necessary unless clinically indicated.
ISSN:0936-8051
1434-3916
DOI:10.1007/s00402-006-0251-1