Femurschachtfractuur bij kinderen jonger dan 4 jaar: Kortere ziekenhuisopname met behulp van tractie thuis

Objective.
Evaluation of home traction as a treatment of femoral shaft fractures in children with the objective to shorten the hospital stay.

Design.
Retrospective.

Setting.
Paediatric Surgical Centre Amsterdam (EKZ/AMC and AZVU), the Netherlands.

Method.
In the period 1991-1995, 18 femoral shaft fractures in children younger then 4 years were treated. In ten of them traction was applied at home (in the other cases the parents refused to co- operate, the home situation was not appropriate, there were additional medical problems or there was a suspicion of child abuse). During follow-up of the group treated at home with traction, angulation, rotational deformity and leg length discrepancy were determined with special attention to complications. The parents' experience of this method was evaluated by telephone (n = 8).

Results.
The median age of the children was 2.4 years. The mean hospital stay was 7 days (range: 3-12), the mean follow-up 2.4 years (range: 1.0-4.3). Angulation, rotational deformities and leg length discrepancy > 1 cm did not occur. Oedema and pain were seen in 1 patient as a result of incorrect treatment at home. In one patient a compartment syndrome occurred after a switch from traction to a plaster treatment in another hospital. With exception of some small practical and informational problems, parents were very pleased with this method.

Conclusion.
Treatment at home of femoral shaft fractures in children with traction is a simple and effective method which reduces the hospital stay to one week with minimal complications. Good patient selection and instructions of the parents are mandatory.