• Markus Dietzel, Leon Ole Schöneberg, Matthias Schunn, Simon Scherer, Michael Esser, Hans Joachim Kirschner, Jörg Fuchs, and Justus Lieber.
• Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tübingen, Germany. markus.dietzel@med.uni-tuebingen.de.
• Eur J Trauma Emerg Surg. 2022 Oct 1; 48 (5): 3393-3399.

PurposeNonsurgical management has been identified as the treatment of choice for femoral shaft fractures in children below four years of age. For various reasons, the surgical approach has become increasingly popular in recent years. The aim of this study is to report results after vertical skin traction and analyze the benefits of this technique as well as to point out advantages compared with surgery in this age group.MethodsThe authors performed a retrospective data analysis, including all patients with femoral shaft fractures below the age of four who were treated with vertical skin traction at our institution between January 2006 and December 2016.ResultsSkin traction for a femoral shaft fracture was performed for 36 patients (mean age 1.6 years; 1 day-3.5 years). The mean duration of traction was 18.5 days (14-30). Complications included soft tissue affections (n = 5), which all healed spontaneously. Consolidation was observed in all fractures. Initial axial deviations and shortening did not change during traction until consolidation (p > 0.05), and no relevant torsion deformity occurred (p = 0.01). Patients gained full weight-bearing within 12.3 days (7-40) following end of traction. At the final follow-up, after a mean of 29.3 months (12-192), leg-length discrepancy (mean 7.1 mm; 5-20) was found on radiograms in nine cases, and axial deviations (mean 7.7°; 5-25) were documented in seven cases. None of the patients had limitations in daily activities or sports.ConclusionSkin traction is a technically easy, safe, and non-invasive treatment modality for femoral shaft fractures in children below the age of four years. Strong results are obtained benefited from a high potential of growth-related correction, and in principle no anesthesia is needed. A prolonged hospitalization and socio-economic factors maintain the ongoing debate in comparison with the surgical approach.Level Of EvidenceLevel III, retrospective.© 2022. The Author(s).

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