OUTCOME OF NON-OPERATIVE MANAGEMENT OF FEMORAL DIAPHYSEAL FRACTURES IN CHILDREN AGED OF 5 YEARS AND BELOW: A RWANDA PERSPECTIVE umuhirejdp@gmail.com

 

OUTCOME OF NON-OPERATIVE MANAGEMENT OF FEMORAL DIAPHYSEAL FRACTURES IN CHILDREN AGED OF 5 YEARS AND BELOW: A RWANDA PERSPECTIVE

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Rwanda

Oral only

Femoral diaphyseal fractures are common pediatric orthopedic injuries, especially in low- and middle-income countries, accounting for up to 40% of related hospital admissions. These fractures, often caused by direct thigh impact or knee force, vary by age in cause and treatment approach. Children under five are usually treated non-surgically due to strong bone remodeling capacity. There is limited data on non-operative treatment outcomes and complications in Rwanda, prompting this study.

This study is a retrospective cross-sectional study to evaluate short term outcome of 60 pediatric patients aged of 5 years and below with closed diaphyseal femur fractures at Rwanda hospitals.

The study involved predominantly male participants (68.3%) with a mean age of 3.84 years, mostly attending nursery school (65%). Falls were the leading cause of injury (53.3%), followed by bicycle (20%) and motor vehicle accidents (13%). Most cases (85%) were isolated injuries. Treatment involved Gallows or skin traction and hip spica, with 40% receiving hip spica alone. After three months, 73.3% showed normal physical exams, while 26% had abnormalities. Complications included acceptable shortening in 30%, malunion in 20%, and joint stiffness in 10%. 71.7% achieved excellent outcomes per the Flynn score.

This study highlights that low-energy trauma, especially falls, is the primary cause of pediatric injuries in early childhood. Conservative treatment using traction and hip results in good functional outcomes. However, complications require careful monitoring. Emphasizing injury prevention, early complication detection, and long-term follow-up can enhance pediatric orthopedic care outcomes.