Comparison Between Closed (Immediate Spica, Traction/Spica Cast) and Open Fixation (Plate Fixation) in Femoral Shaft Fractures in Children Below Nine Years Old Who Had Recoursed to Mashhad Imam Reza Hospital From 2002 to 2007

Femur fracture is one of the most common fractures in children. Certain parameters such as the patient’s age, the exact location of fracture, type of fracture, the mechanism of fracture, and the accompanying injuries determine which one of the many treatment techniques be used in each case. We aimed to compare the results of close and open techniques in pediatric femoral shaft fractures fixation (under 9 years old). In this study, the clinical and radiologic results of the femur shaft fracture cases in children below 9 years old who recoursed to Mashhad Imam Reza Hospital. Twenty six cases of femoral shaft fractures in 25 children (14 boys and 11 girls) which could be classified in three different classes; nine upper third (proximal) femoral shaft fractures, 14 middle third (midshaft) femoral fractures, three lower third (distal) femoral shaft fractures. Thirteen fractures (50%) were treated with immediate Spica cast, six fractures (23%) received traction and Spica cast, and surgical fixation with plate was carried out in the remaining seven cases. After a follow-up interval of at least 5 years, angle deformity was the most common complication observed in 32% of the studied patients. Limb length discrepancy and rotational deformity were observed in 24% and 16% of the cases. Treated with immediate Spica cast proved to have the highest complication prevalence of all (92.2%) and was followed by traction and Spica cast (83.4%) and were observed in patients’ surgical fixation with plate (14.3%). According to the results, internal fixation with plates can be considered an appropriate technique in cases of pediatric femoral shaft fractures.