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ACUTE FRACTURES OF THE SHAFT OF THE FEMUR IN CHILDREN: A Report of the Treatment and Results Attained in Eighty-six Acute Fractures of the Shaft of the Femur in Eighty-five Children, With a Resume of Various Types of Treatment and Results Attained by Other Surgeons.

CONWELL, H. EARLE
The Journal of Bone & Joint Surgery: July 1929
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1. There is unlimited literature on fractures of the femur in children.

2. The following are the main forms of treatment of fractures of the femur in children: [See the Table in Source Pdf.]

Method C has several subdivisions,-such as: Buck's extension; skeletal traction (calipers and Steinmann pins) in the horizontal or perpendicular position (this method is rarely used and should not be applied except when amputation is being considered or when no other method is applicable. The interference with the epiphyseal growth should always be kept in mind when using skeletal traction in children); suspension and extension of one or both thighs in a perpendicular elevation with adhesive traction to the skin; extension of one or both thighs in a horizontal or perpendicular position, with the aid of the Thomas or the Hodgen splints; or the Bradford frame.

3. Excellent results are obtained by various surgeons by all of the above methods. The suspension and extension method is the most popular.

4. Treatment by open reduction should be the last resort, and usually is not necessary in the treatment of fractures of the femur in children.

5. A summary of the results of the cases treated by plaster cast shows that better results are obtained in the very young than in the older child.

6. A summary of the cases treated in plaster cast and extension shows that better results are obtained in the older child.

7. A summary of the cases treated by suspension and extension shows that better results are obtained in all ages up to the age of ten and eleven years than in either the series treated by plaster cast or in the series treated by plaster cast and extension.

8. Careful physical and radiological examination with careful history of the accident should always be made. Immediate reduction with aid of fluoroscope should be done. Every case of fractured femur should be considered an emergency and immediate treatment should be given following injury.

9. Unnecessary manipulation of the fractured limb should never be done. General anaesthetic, preferably ether, should be given at the time of reduction, unless general condition contraindicates; and, when this is the case, local anaesthetic should be used.

10. Definite attention should be given to the conservation of the muscle and the motion of the adjoining joints, thereby lessening the prolongation of convalescence, as well as preventing grave deformities and permanent disabilities. To aid this, frequent applications of physiotherapy treatment are recommended. Frequent radiographs should be made.

11. Good alignment is most important,-then bone approximation.

12. It is definitely concluded that compensatory lengthening does take place, also correction of poor alignment, but chiefly in patients before the age of eight years.

13. The suspension and extension method is by far the most comfortable dressing, and best results have been obtained by this method. This method facilitates frequent daily examinations, frequent checks with x-ray, dressings in compound wounds; makes easy the application of radiant light, hot baths, and active and passive motion. All of these make for a shorter convalescence and better functional results.

14. Frequent inspection of the patient should be made at out-patient clinic, following discharge from the hospital, and patient should be kept under observation until entirely well.

15. Granting that compensatory lengthening does take place and that serious misalignments are corrected in fractures of the femur in children, no surgeon is justified in neglecting any one of the important things which should be done immediately following a fracture of the femur.

16. In the treatment of children the mental factor is to be considered at all times.

(C) 1929 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.

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