Date: Wed, 17 Apr 2002 22:50:48 +0530

Subject: Maluniting Pediatric Femur Fx

Dear Colleagues,

Presenting the following case for your valuable opinion regarding management:

A 4 year old male child was admitted to our hospital today with history of having sustained fracture of right femur 21 days back. He was treated elsewhere in gallows traction. On removal of the traction today there were multiple blisters over both the lower limbs, some of them being infected. The right lower limb is in complete external rotation and is shorter by about 1 inch. Xrays taken today are attached.

Xrays taken on the day of injury are not available. Awaiting the opinions of list members. Thanking you all in advance,

Regards,

Dr. R. Sachidanandan
Sree Sudheendra Medical Mission Hospital
Cochin,INDIA.

Date: Wed, 17 Apr 2002 19:05:52 +0100

From: chris wilson

Shortening doesn't matter, as there will be overgrowth with time. The angular deformities in the coronal and sagital planes will correct well within a few years. How much external rotation is there?If the child can walk at all I would do nothing.There is abundant callus,and it is probably solid even now. It's absolutely the worst time to think about intervening surgically. Derotation osteotomy can be performed in a year or so if really necessary.

Chris Wilson
Knee and Trauma Surgeon
University Hospital, Cardiff, UK

Date: Tue, 16 Apr 2002 04:40:30 -0600

From: Thomas A. DeCoster

4 year olds have tremendous remodelling potential and I have seen worse alignment than this end up totally normal so be careful if you try to do something.

TD