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February 23, 1957


JAMA. 1957;163(8):634-637. doi:10.1001/jama.1957.02970430024008

• The healing of traumatic fractures of the shaft of the femur was studied in 100 children, who were followed up for an average of 5.5 years. Traction was applied initially in 50. Closed reduction, with application of plaster casts but without initial fraction, was used in 34. The fracture healed with from 1 to 6 cm. shortening in 45 of the 84 patients with fractures treated by closed means. Growth stimulation produced compensation in 42 of these so that equalization of lengths resulted. There were 9 instances of overgrowth in the 23 displaced fractures that united with normal length after closed treatment. Length remained normal after 16 nondisplaced fractures. Stimulation of growth was proportional to the degree of soft-tissue injury. Overgrowth deformity was a permanent condition. Open reduction was done in 16, and there were 11 instances of overgrowth, 2 of infection, and one refracture in this group. There is virtually no indication for the use of accurate open reduction in this type of fracture. Sixty-five of the 100 fractures were followed by acceleration of growth, so that, when the fracture had united with shortening, the eventual result was the practical equalization of leg lengths. The deviations in rotation about the longitudinal axis and the deviations in alignment corrected spontaneously, so that subsequent correction was not warranted. There were no cases of nonunion. Criteria for satisfactory reduction are suggested. Direct immobilization by plaster spica had several advantages over traction. If traction is used, the danger of Volkmann's ischemic contracture must be kept in mind. Pain was the most reliable warning of ischemia, and a child who is sobbing with pain during the first night must be seen at once and not left without examination until morning. The results of the two closed methods were otherwise comparable.