[Techniques of lower limb immobilization in children and adolescents].

Abstract

Objective: Conservative treatment for femur shaft fractures in small infants and for distal femur and lower leg fractures with sufficient stability in every age, if axial deformities, including rotational failures, are reliably avoided and normal limb function without pain is ensured.

Indications: Femur shaft fractures in infants up to 3 years of age. Undisplaced, stable fractures and/or fractures within the range of age-dependent spontaneous correction as well as stable reducible fractures of distal femur and of the whole lower leg, especially buckle, greenstick and isolated tibia fractures, mainly in children less than 10 years of age.

Contraindications: Femur shaft fractures in children > 3 years of age or > 15 kg body weight. Instable and displaced fractures at distal femur and whole lower leg beyond the range of age-dependent spontaneous correction, especially if the fibula is involved.

Surgical technique: 1. Spica cast in children in the first and second year of life for femur shaft fractures. 2. Closed split long leg cast for distal femur fractures and for fractures of the proximal tibia and lower leg shaft fractures as well as in all small infants who easily slip out of shorter casts. 3. Closed split lower leg cast or wide lower leg splint for distal lower leg fractures including ankle fractures and distorsions as well as fractures of the foot, except for small infants who easily lose lower leg casts and need long leg casts even in distal lower leg fractures. 4. Sarmiento cast for special situations or for functional treatment.

Postoperative management: Stable fractures: Cast removal after 3-4 weeks, clinical control of consolidation and start of mobilization. Fractures displaced or reduced within the range of spontaneous correction: x‑ray control of alignment after 1 week to exclude secondary displacement, closing the cast if necessary, x‑ray control of consolidation without cast 4 weeks later, further immobilization if necessary depending on age and extent of callus formation.

Results: With consequent and professional postoperative management, results of conservative treatment for femur shaft fractures in small children, in distal femur and lower leg fractures are good. Skin complications especially at the heel occur in about 2% of cases and these must be prevented with adequate padding.