The Effect of a Femoral Fracture Sustained before Skeletal Maturity on Bone Mineral Density: A Long-Term Follow-Up Study

Background and Purpose. The possible effect of pediatric femoral fractures on the bone mineral density (BMD) is largely unknown. We conducted a study to investigate BMD in adults who had sustained a femoral shaft fracture in childhood treated with skeletal traction. Materials and Methods. Forty-four adults, who had had a femoral fracture before skeletal maturity, were reexamined on average 21 (range 11.4) years after treatment. Our follow-up study included a questionnaire, a clinical examination, length and angle measurements of the lower extremities from follow-up radiographs, and a DEXA examination with regional BMD values obtained for both legs separately. Results. At follow-up femoral varus-valgus (P=0.001) and ante-/recurvatum (P=0.001) angles were slightly larger in the injured lower-limb compared to the contralateral limb. The mean BMD of the entire injured lower-limb was lower than that of the noninjured (1.323 g/cm2 versus 1.346 g/cm2, P=0.003). Duration of traction was the only factor in multiple linear regression analysis that was positively correlated with the BMD discrepancy between the injured and noninjured lower-limb explaining about 17% of its variation. Conclusion. The effect of a femoral fracture sustained during growth is small even in patients treated with traction.