Clinical and functional outcomes of Paediatric femoral shaft fractures managed non-operatively at Nkhotakota District Hospital, Malawi

Abstract

Background
Femoral shaft fracture is a common paediatric injury, managed non-operatively with skin traction in Malawian public hospitals. The
clinical and functional outcomes of this treatment modality are unknown in Malawi.
Methods
We retrospectively identified all children who were managed at Nkhotakota District Hospital with skin traction after sustaining closed
femoral shaft fractures from January 1, 2013 to December 31, 2016. We collected demographic characteristics and treatment history
from the patient’s inpatient medical records, then invited each patient to undergo in-person follow-up clinical and functional assessment.
Results
We identified 149 patients. Gallows traction 26 (17%) and 123 Bucks skin traction (83%). The mean age for Gallows traction was 10
months (95% CI: 8-11), most were males (16, 62%). Fall was the most common cause of injury (19, 73%), and mean hospitalization
of 15.8 days (95% CI: 13.8-17.9). Eighteen patients (69%) were followed up at a mean of 4.2 years after discharge, all were full weight
bearing, had achieved radiographic fracture union, and had no functional limitations or pain during regular activity. Buck’s skin traction
mean age was 5.2 years (95% CI: 4.7-5.8), most were males (82, 67%), and fall (85, 69%). We followed up 83 patients (67%) at a mean
of 4.1 years after hospital discharge, all of whom had achieved radiographic fracture union. All but one patient were full weight bearing
and had normal gait. At follow-up, 14 patients (17%) reported some level of pain, 5 patients reported that their injury limited their
return to household chores, and 2 reported that their injury also limited their return to school.
Conclusion
Despite the limitations of this study, non-operative management of paediatric femoral shaft fractures at Nkhotakota District Hospital
may have good clinical and functional outcomes and minimal complications. A future prospective study may be helpful to confirm
these findings.