A study was done of twelve patients (seven boys and five girls) who,
because of multiple injuries or a head injury, had been managed with
compression plating of a unilateral or bilateral femoral-shaft fracture at
a level-I trauma center from 1986 through 1990. The patients had a total of
fifteen fractures. The average age at the time of the injuries was eight
years (range, five years to nine years and eleven months). There were nine
closed fractures and six open fractures; three of the open fractures were
Grade I; two, Grade II; and one, Grade IIIA, according to the criteria of
Gustilo et al. Each patient had an average of three associated injuries.
All fifteen fractures had healed clinically and radiographically at an
average of eight weeks (range, six to twelve weeks) after the operation.
There were no infections. Anatomical alignment was obtained in fourteen
limbs. One fracture healed with 13 degrees of anterior angulation. The
compression plates were removed at an average of ten months (range, three
to twenty-four months) after the index operation. At the latest follow-up
evaluation (average, twenty-six months; range, eleven to fifty-seven
months), no patient had restriction of activities due to the femoral
fracture. Scanograms revealed overgrowth of the injured femur averaging 0.9
centimeter (range, 0.3 to 1.4 centimeters) in seven patients who had an
uninjured contralateral femur. We believe that plate fixation of the femur
is a good treatment option for children who have a femoral shaft fracture
and a major head injury or multiple injuries, or both.