Traumatic simultaneous bilateral femur and tibia shaft fracture in an 8-year-old male child: An unusual case report

Kavin Sathish1, S Chockalingam2

Department of Orthopaedic surgery, Kauvery Hospital, Tiruchirappalli, Tamilnadu

Introduction

Bilateral simultaneous fracture of femur and tibia are very rare in children. There have been few reports on traumatic bilateral femur and femoral neck fractures in paediatric age group [1]. This type of injury is caused by high velocity trauma. The purpose of this case report was to highlight the presentation, treatment, and outcomes of the rare injury.

Case report

An 8-year-old male child presented to emergency with bilateral femur and tibia closed fracture sustained in motor vehicle accident. The patient had associated facial injury, left sided rib fracture and liver injury. On arrival child was under ventilator support (GCS – 2t/15). CT brain and face showed left blow out fracture and left TMJ dislocation. CT abdomen showed grade 2 liver injury. Both lower limbs required POP slab support with skeletal traction (Calcaneum). The child was admitted to the Paediatric intensive care unit and was co-managed by ortho surgeon, neuro surgeon, plastic surgeon and intensivist team. After 4 days we planned bilateral femur retrograde TENS nail by closed reduction and bilateral tibia antegrade TENS nail. After general condition improved, walker support mobilization was done with partial weight bearing. A follow up review showed that the fractures had healed well by 5th post injury month. The TENS nails were removed from both femur, and tibia at 6th month. Range of motion of both hip, knee and ankle joints were full and painless. There was no limb length discrepancy.

Discussion

Traumatic bilateral femur or bilateral tibia fracture in children are less common and have been reported in a few articles .But, traumatic bilateral, simultaneous, femur and tibia shaft fractures in children are very rare. Mortality after bilateral femoral fractures in the adult population ranges from 6-32% [2]. In the adult literature, deep vein thrombosis/pulmonary embolism, hemorrhage, and pneumonia have been reported as potentially serious complications.[3] It is well described that children have different physiologic response to trauma that is functionally and mechanistically different compared to adults.[4] Pediatric patients have decreased systemic inflammatory activation which may be protective against mortality in the polytrauma situation.[5]

Conclusion

According to the best of our knowledge, this is the first case report with bilateral femur and tibia shaft fracture in children. Early surgical management and appropriate rehabilitation program must be developed to reduce in-hospital stay.

References

  • Saied A, Jalili A. Bilateral femoral neck fractures in a child. Eur J Orthop Surg Traumatol. 2009;19:349–351
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Dr. R. S. Kavin
DNB, Dept of Orthopedics

 

Dr Chokalingam

Dr. S. Chockalingam
Orthopaedic Surgeon

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