Internal fixation of fractures in children and adolescents. A comparative analysis.

A retrospective analysis of 4,411 consecutive pediatric fracture patients managed between 1979 and 1983 demonstrated that only 3.6% (170 patients) required internal fixation. Two patient groups with sufficient follow-up study were compared: Group 1-90 skeletally immature children and young adolescents, and Group 2-66 skeletally mature adolescents. Upper-extremity fractures, especially of the distal humerus, and displaced epiphyseal fractures were the major indication for internal fixation in Group 1, while lower-extremity diaphyseal and intra-articular fractures predominated in Group 2. Complication rates were higher than expected but fortunately most were minor-18% in Group 1 and 12% in Group 2. The results of this study demonstrate that internal fixation can be beneficial in selected fractures in children and adolescents in preventing major complications, such as premature epiphyseal closure and malunion, and in restoring and maintaining normal extremity growth and function.