Complications in operatively managed pediatric femoral shaft fractures

Objectives: Despite being the strongest long bone in the body, femur shaft fractures (FSFs) remain steadily prevalent in Saudi Arabia and globally. The goal of treatment is to achieve fracture healing with the least complications. Therefore, this study intended to determine the complications in pediatric FSFs, which were operatively managed. Methods: This study is a retrospective analysis of 76 pediatric FSFs. The inclusion criteria included age ≤14 years, FSFs operatively treated in the study center, at least one-year follow-up, and admission between January 1, 2012, and January 1, 2020. Pathological fractures and patients with neuromuscular or syndromic conditions were excluded from the study. Results: Seventy-two patients (81.9% boys, mean age 8.1 years) with 76 FSFs were analyzed. Most injuries were from motor vehicle accidents (41.6%), falls (29.1%), and pedestrian trauma (15.2%). Titanium was used in 47 (61.8%). Plating was used in 16 (21%), rigid nails in eight (10.5%), and hip spica under general anesthesia in five (6.5%). Out of those 76 fractures, 17 had developed complications. These complications varied in their significance, including limb length discrepancy (LLD) (five), non-union (three), 15° angulation (three), skin irritation due to cast soiling (two), skin swelling due to prominent flexible nail (one), surgical site infection (one), osteomyelitis (one). LLD was significantly associated with increased weight, fracture pattern, non-union, and definitive fixation time. Conclusion: Overall complications in operatively treated pediatric FSFs were low and not disabling. LLD was the most common with a significant association with increased weight, unstable fracture pattern, non-union, and definitive fixation time.