Treatment of pediatric femur fractures with the Pavlik harness: multiyear clinical and radiographic outcomes.

BACKGROUND:
Femur fractures account for 1.4% to 1.7% of all pediatric fractures. The use of the Pavlik harness has been described for infants; however, previous reports have included only short-term follow-up. This study describes the multiyear clinical and radiographic results from patients younger than 6 months of age treated with a Pavlik harness.

METHODS:
The clinical and radiographic records were reviewed for all children under the age of 6 months who were treated with a Pavlik harness for an isolated femoral shaft fracture at a level 1 pediatric trauma center. Radiographs were obtained at final follow-up, as well as a standing full-length anteroposterior scanogram. Clinical examination was completed and inquiry regarding patient activity limitations, complications of treatment, and overall parent/provider satisfaction was made.

RESULTS:
Ten patients with 10 fractures met inclusion criteria. The average age of the patients at the time of injury was 2.2 months. The average duration of Pavlik harness treatment was 43 days (range, 31 to 54 d). The average age at final follow-up was 5.2 years (range, 2.6 to 7.3 y). At final follow-up, average angulation was 3 degrees valgus (range, 0 to 8 degrees) and 5 degrees procurvatum (range, 0 to 24 degrees). Only 1 patient had a measurable leg-length discrepancy of 7 mm at final follow-up. There were no complications noted.

CONCLUSIONS:
It is felt that pediatric patients have a significant potential for bone remodeling and that any angulation at the time of fracture union will remodel. Our study supports this notion as the final angulation at follow-up averaged 3 degrees valgus and 5 degrees procurvatum. In the patient group presenting with >20 degrees of angulation at the time of injury, final angulation averaged 5 degrees valgus and 11 degrees procurvatum. Treatment with the Pavlik harness provides for excellent clinical outcomes with a minimal complication rate. However, some patients, especially those presenting with a high degree of angulation, may have some degree of persistent radiographic angulation.