Fractures of the femur in children are not as common as those of adults but presents significant morbidity when they do occur. Such fractures present in diverse pattern in terms of age, causes, season, treatment and outcome. Presentation and treatment is influenced by age of the patients, locality of practice, available resources and experience of treating surgeons.
To evaluate the pattern of presentation, treatment and outcome of fractures of the femur in children seen in a regional trauma centre in Nigeria with the aim of proffering recommendations.
Data of all cases of femoral fractures in children treated at the trauma centre from 1st January 2007 to 31st December 2011 was evaluated retrospectively from the trauma database which had been developed prospectively. Demographic information of the patients, cause of injury, treatment offered and outcome were extracted and analyzed. Descriptive statistics were generated and presented. Inferences were drawn from the observed results as deemed necessary.
During the period under study, 314 cases of femoral fractures were seen in children constituting (23.5%) of the 1334 fractures of the femur treated in the centre. Males predominated overall but below the age of 5 years the male to female ratio was approximately 1:1. Road traffic crashes (209, 66.6%) and falls from heights (70, 22.3%) including those from fruit trees (32, 10.2%) were the major causes of the fractures especially in children older than 10 years with Mean age (SD) been 11.5 (6.3) years. Below 10 years ground level falls and assaults were the main causes; Mean age (SD) = 5.2 (3.6) years. Most of the fractures were of the closed type (286, 91.1%) whereas open fractures were only 28 (8.9%). Two hundred and two of the cases (64.3%) were treated by non-operative methods while surgery including internal fixation was done for 91 cases (29%), external fixation for 13 cases (4.1%) and amputation in one case. Two hundred and eighty-one of the cases (89.5%) of the fractures had attained significant radiological union at 12 weeks after injury while 282 patients had been discharged from hospitalization as at 6 weeks from admission. Infection was recorded in 8 cases (2.5%), while malunion was recorded in 5 cases (1.6%) and non-union was recorded in one patient.
Femoral fractures in children are not as common as those of adults in the centre. Road traffic crashes and falls from heights including falls from seasonal fruit trees were major causes of femoral fractures in children seen at the centre. Preventive measure should include children road safety advocacy and implementation of policies to reduce the population of out-of-school children so as to reduce risk exposure to causative factors.