Early Outcome of Lower Limbs Length Discrepancies and Angular Deformities in Skin Traction of Femoral Shaft Fractures in Children Aged Between One- and Five-years at Kenyatta National Hospital

Abstract

Background: Femur shaft fractures make for 0.7% to 1.7% of all pediatric fractures and 3.5% of long bone extremities, and 20% of children hospitalized with fractures. These injuries have a bimodal distribution with two peaks: early childhood (2–3 years old) and adolescence (17–18 years old). The management is mostly operative and non-operative with non-operative being the gold standard for children below six years. However, non-operative care using Pavlik harness, hip Spica, or skin traction as definitive treatment can cause some complications. These complications can affect the skin and other soft tissues, bones union malalignment causing skin slough, neurovascular damage or contracture, and lower limb abnormalities like angular, rotational, and length discrepancy although little has been studied in Kenya on lower limbs malunion in children femur shaft fractures managed conservatively with skin traction. Objectives: To determine the early outcome of lower limbs deformities in femoral fractures union treated in traction in children between one and five years of age at three weeks traction with delayed hip Spica and six weeks traction as definitive treatment at Kenyatta National Hospital. Materials and methods: This was a three-month observational cross sectional study. It was carried out at Kenyatta National Hospital in the paediatric orthopaedic ward. The study population were patients aged between 1 year and 5 years of age with femur shaft fracture treated in skin traction with or without delayed hip Spica. Convenience sampling was used to recruit 34 patients who met the inclusion criteria. For lower limbs length discrepancies estimation, a tape measure was used to measure the injured and non-injured limbs length for comparison. And for angular deformities check radiographs of the injured femur with anteroposterior and lateral views were done at three and six weeks, and a goniometre was used to measure the angles for the coronal and sagittal deformities of the injured femur. Data collected was entered and analyzed using SPSS version 25. Student t-test was used to compare the two treatment methods based on the early outcomes investigated. Results: The mean age of paediatric patients with femur shaft fractures was 3.29(SD±1.03) years with a minimum of one year and maximum of five years. The ratio of male to female was 1.8:1. Majority of the patients, 55.9%(n =19) had injury due to fall from height, 44.1%(n =15) were classified as 32D4.1, 41.2%(n =14) were classified as 32D5.1, 8.8%(n =3) were classified as 32D5.2 while 5.9%(n =2) were classified as 32D4.2. Limb length discrepancy was significantly xvii higher in patients managed with six weeks of traction (1.26 ±0.4 cm) compared to those with three weeks of traction followed by delayed hip spica (0.92 ±0.5 cm), though both approaches-maintained discrepancies within recommended limits (t = -1.862, p = 0.040). There was a significant difference in sagittal plane deformity between the two approaches, with higher deformity in those managed with six weeks of traction (10.6 ±3.8 degrees) compared to three weeks (6.88 ±3.5 degrees, t = -3.725, p = 0.009). Similarly, coronal plane deformity was higher in the six-week traction group (9.2 ±2.5 degrees) compared to the three-week group (6.0 ±2.7 degrees, t = -3.2, p = 0.003). Despite these differences, deformities in both planes were within the recommended limits. Conclusion and recommendations: Both three weeks of traction followed by delayed hip spica and six weeks of traction as definitive treatment effectively manage pediatric femoral shaft fractures within acceptable deformity limits, with the latter showing higher but still acceptable deformities; therefore, tailored treatment based on individual patient needs and continuous monitoring is recommended.