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External Fixation in Pediatric Femur Fractures: A Review

External fixation is a commonly used technique in the management of pediatric femur fractures. This review aims to provide a comprehensive overview of the use of external fixation in pediatric femur fractures, including indications, techniques, complications, and outcomes. The article will also discuss the advantages and disadvantages of external fixation compared to other treatment modalities. By examining the available literature, this review will provide valuable insights into the use of external fixation in pediatric femur fractures and help guide clinical decision-making.

1. Introduction

Femur fractures are relatively common in children, accounting for approximately 1-2% of all pediatric fractures. The management of these fractures can be challenging due to the unique anatomical and physiological characteristics of pediatric patients. External fixation is one of the treatment options available for pediatric femur fractures and has gained popularity in recent years. This technique involves the use of pins or screws inserted into the bone, which are then connected to an external frame to stabilize the fracture.

2. Indications for External Fixation

External fixation is indicated in certain cases of pediatric femur fractures, particularly when other treatment modalities may not be suitable or effective. The following are some common indications for the use of external fixation:

  • Open fractures: External fixation can be used as a temporary measure to stabilize open fractures and prevent further soft tissue damage.
  • Multiple fractures: In cases where a child has multiple fractures, external fixation can provide stability and allow for early mobilization.
  • Pathological fractures: External fixation can be used to stabilize fractures caused by underlying bone tumors or other pathological conditions.
  • Complex fractures: In complex fractures, such as those involving the growth plate or intra-articular extension, external fixation can provide better control and alignment.

3. Techniques of External Fixation

There are several techniques of external fixation that can be used in the management of pediatric femur fractures. The choice of technique depends on various factors, including the age of the child, the type of fracture, and the surgeon’s preference. The following are some commonly used techniques:

  • Unilateral external fixation: This technique involves the placement of pins or screws on one side of the fracture site, with an external frame attached to provide stability.
  • Bilateral external fixation: In this technique, pins or screws are inserted on both sides of the fracture site, and an external frame is used to connect them.
  • Hybrid external fixation: This technique combines the use of external fixation with other modalities, such as intramedullary nails or plates, to provide additional stability.

4. Complications and Outcomes

Like any surgical procedure, external fixation is associated with certain complications. However, with proper technique and careful patient selection, the risk of complications can be minimized. Some potential complications of external fixation in pediatric femur fractures include:

  • Pin tract infection: This is the most common complication associated with external fixation. It can be managed with appropriate wound care and antibiotics.
  • Delayed union or nonunion: In some cases, the fracture may take longer to heal or may not heal at all. This can be due to various factors, such as poor bone quality or inadequate fixation.
  • Malunion or deformity: Improper alignment or fixation can result in malunion or deformity of the femur. This may require additional surgical intervention to correct.
  • Neurovascular injury: Although rare, neurovascular injury can occur during the insertion of pins or screws. Careful preoperative planning and intraoperative monitoring can help prevent such injuries.

Despite these potential complications, external fixation has been shown to have favorable outcomes in the management of pediatric femur fractures. Studies have reported high rates of fracture union, good functional outcomes, and low rates of complications when performed by experienced surgeons using appropriate techniques.

5. Advantages and Disadvantages of External Fixation

External fixation offers several advantages over other treatment modalities for pediatric femur fractures. Some of the advantages include:

  • Early mobilization: External fixation allows for early weight-bearing and mobilization, which can lead to faster recovery and reduced hospital stay.
  • Minimal soft tissue disruption: Unlike intramedullary nailing or plating, external fixation does not require extensive soft tissue dissection, reducing the risk of complications.
  • Adjustability: The external frame used in external fixation allows for adjustments in alignment and lengthening, which can be beneficial in certain cases.

However, external fixation also has some disadvantages that need to be considered. These include:

  • Pin site care: External fixation requires regular pin site care to prevent infection. This can be time-consuming and may require additional resources.
  • Frame-related discomfort: The external frame can cause discomfort and skin irritation, particularly in younger children. Proper padding and monitoring are necessary to minimize these issues.
  • Longer treatment duration: External fixation may require a longer treatment duration compared to other modalities, such as intramedullary nailing.


External fixation is a valuable treatment option in the management of pediatric femur fractures. It offers advantages such as early mobilization, minimal soft tissue disruption, and adjustability. However, it is important to consider the potential complications and disadvantages associated with this technique. By carefully selecting appropriate cases and using proper techniques, surgeons can achieve favorable outcomes and minimize the risk of complications. Further research and long-term follow-up studies are needed to provide more evidence on the efficacy and outcomes of external fixation in pediatric femur fractures.

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