Korrektureingriffe nach operationen bei femurschaftfrakturen im kindesalter

Literature offers divergent data concerning peri-und postoperative complication rates and corrective procedures following operative treatment of femoral shaft fractures in children. Target of this study was to evaluate all intraand postoperative complications of elastic stable intramedullary nailing (ESIN) versus external fixation of femoral shaft fractures in children. In particular we analysed all technical problems, all cases of malalignment and long-term results regarding the functional outcome. Functional outcome was measured by clinical examination and by using the HARRis-Score. During a 5-year period (March 2002 to April 2007) 43 children with femoral shaft fractures were treated with flexible intramedullary nailing (n=31) or external fixation (n = 12). Several peri-and postoperative complications as well as corrective procedures occurred (ESIN n = 11, External fixation n = 5). Technical problems occurred more frequently in elastic stable intramedullary nailing. Despite that, clinical examination at follow-up showed no limb length discrepancy greater than 1.5 cm or malalignment >10°. Functional outcome was good or very good in all patients. Concerning complications, there was a tendency towards patient's age (older than 12 years) and weight (greater than 40 kg). Our data as well as reports in literature show, that operative treatment of femoral shaft fractures in children can be associated with a high rate of problems and complications. However, these problems and complications do not impair the functional long-term results, which are generally good. Redo operations have to be strictly avoided by correct indications and knowledge of the technical aspects as well as the basic principles of biomechanics.