Simultaneous Bilateral Femur Fractures in Children: A Case Series from a Pediatric Level I Trauma Center and Review of the Literature.

BACKGROUND

Bilateral femur fractures are rare in the pediatric population with few cases reported in the literature. The purpose of this study was to review our institutional experience with a case series of simultaneous bilateral femur fractures to highlight the presentation, treatment, and outcomes of these rare injuries as well as perform a preliminary comparison to similar unilateral femur fractures in order to identify any clinically relevant differences that may guide future management.

METHODS

We undertook a retrospective chart review of patients who had presented with simultaneous bilateral femur fractures between 2007 and 2017 with a minimum of 1-year of follow-up. Descriptive information was provided about the case series of bilateral femur fracture patients with subsequent further analysis comparing unilateral and bilateral femur fractures.

RESULTS

Eight patients (7 males, 1 female) were identified after chart review. Mean age at the time of injury was 11 years (8 to 15 years). Mechanism of injury was high energy trauma in 7 of 8 patients. Six of 8 patients presented with at least one significant associated injury. All patients underwent operative fixation bilaterally. Average length of stay was 12 days (range 4-27 days). Four patients required admission to inpatient rehab facility. Complete healing occurred in all patients. One patient experienced unilateral genu valgum deformity treated successfully with growth modulation. Another patient experienced a unilateral bony bar of approximately 20% of the physis which did not result in angular deformity or limb length discrepancy. After comparing to a matched unilateral femur fracture cohort, we found that patients who sustained bilateral femur fractures had a significantly higher number of associated injuries as well as greater length of stay (p<0.05). There was no statistical difference in complications.

CONCLUSIONS

Our case series illustrates the presentations and outcomes of this rare injury pattern in children along with a few potential differences that distinguish bilateral femur fractures from unilateral fractures. These results may help guide healthcare personnel in making management decisions regarding this rare injury.Level of Evidence: IV.