Summary
A prospective study of femoral shaft fractures in children under the age of 14 years has been carried out in 71 patients who were reviewed both clinically and radiographically at yearly intervals. The processing of data has been carried out by univariate and multivariate analysis.
Femoral overgrowth (F.O.) averaged 8.63 mm (range 1–21 mm), and was found to be influenced by age (greater overgrowth in children between 3 and 9 years), the initial displacement of the fracture (greater overgrowth in severely displaced fractures), and overriding of the fragments at the time of healing (the greater the overriding the lesser the overgrowth). Consideration of these factors allowed overgrowth to be predicted from the time of fracture. Overgrowth occurred in all children over 2 years of age, and took place mainly during the first year after the fracture. It continued, although to a lesser extent, during the second year, and for as long as the fifth year in 27%. After this time the growth rate of both femurs was equal in all the children. Ipsilateral tibial overgrowth was present in only 60% of the children and averaged 1.05 mm (1–5 mm).
Résumé
Les auteurs ont réalisé une étude prospective des fractures de la diaphyse fémorale chez les enfants de moins de 14 ans. Elle a porté sur 71 patients qui ont été revus cliniquement et radiologiquement à intervalles d'un an. Les données recueillies ont fait l'objet d'analyses uni- et multivariantes.
L'hyperallongement du fémur a atteint 8,63 mm en moyenne (de 1 à 21 mm). Il est influencé par l'âge (il est plus important chez les enfants de 3 à 9 ans), par le déplacement initial (il est plus marqué dans les fractures à grand déplacement), et par le chevauchement des fragments lors de la consolidation (l'importance de l'allongement varie en raison inverse de celle du chevauchement). La connaissance de ces facteurs permet de prévoir le degré d'hyperallongement au moment même de la fracture. Cet allongement survient chez tous les enfants de plus de 2 ans, et surtout pendant la première année d'évolution. Il se poursuit, mais plus lentement, pendant la deuxième année et même jusqu'à la cinquième année dans 27% des cas. Ensuite, chez tous les enfants, les deux fémurs continuent à croître de façon égale. L'allongement du tibia homolatéral n'a été observé que chez 60% des enfants, il était en moyenne de 1,05 mm (de 1 à 5 mm).
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Martin-Ferrero, M.A., Sanchez-Martin, M.M. Prediction of overgrowth in femoral shaft fractures in children. International Orthopaedics 10, 89–93 (1986). https://doi.org/10.1007/BF00267747
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DOI: https://doi.org/10.1007/BF00267747