The Journal of Bone and Joint Surgery, Vol 73, Issue 3 429-439, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
Ipsilateral fractures of the femur and tibia in children and adolescents
WW Bohn and RA Durbin
Department of Orthopaedic Surgery, Children's Hospital, Columbus, Ohio.
We reviewed forty-four consecutive cases of simultaneous fracture of the
ipsilateral femur and tibia in forty-two children and adolescents. One
patient died from concomitant cerebral injury and one had a fat-embolism
syndrome. Thirty patients (thirty-two limbs) had an average follow-up of
5.1 years (range, one to fourteen years). Nineteen patients who had an
average follow-up of 6.8 years were available for personal examination and
roentgenography. Age was found to be the most important variable as related
to clinical course. Of the fifteen patients who were less than ten years
old, three had an early complication; the average time to full, unsupported
weight-bearing was thirteen weeks; and the average combined femoral and
tibial overgrowth was 1.8 centimeters. Of the fifteen children who were
more than ten years old, eight had an early complication; the average time
to full, unsupported weight-bearing was twenty weeks; and there was
variable femoral and tibial growth. The juxta-articular pattern of fracture
was associated with the highest incidence of early and late problems. Most
of the children who were younger than ten years were treated successfully
with closed methods, but limb-length discrepancy developed. The children
who were older than ten years were treated successfully with reduction and
fixation of the femoral fracture, but had a high rate of complications.
There was a high incidence of concomitant injuries to the ligaments of the
knee, resulting in long-term dysfunction of the extremity. Of the nineteen
patients who had long-term follow-up, only seven had normal function
without major problems. The remainder had a compromised result due to
limb-length discrepancy, angular deformity, or instability of the knee,
particularly ligamentous instability.
CiteULike 
Connotea 
Del.icio.us 
Technorati What's this?
