Treatment injuries are rare in children's femoral fractures

Figures & data

Table 1. Characteristics of the 30 claims for compensation submitted to the PIC

Age	Injury	Frac-ture ^a	Treatment institution ^b	Primary treatment ^c	Complication ^d	Compensation claim	Compensation, reason	Avoidable
0.1	Fall < 1 m	S	HC	T		Delay in diagnosis	No, no effect on outcome	Yes
0.5	Fall < 1 m	M	HC	None		Delay in diagnosis	No, no effect on outcome	No
0.6	Fall on level	S	CH	None		Delay in diagnosis	Yes, inadequate clinical examination	Yes
1,2	Fall on level	S	CH	T + C		Delay in diagnosis	Yes, fracture dislocated due to delay	Yes
1.6	Fall on level	S	HC	C		Delay in diagnosis	No, no effect on outcome	Yes
1.8	Fall on level	S	HC	T	SU	Inadequate casting	Yes, inadequate cast padding	Yes
2.0	Child abuse?	S	CH	T		Pain and suffering	No, satisfactory treatment	No
2.1	Child abuse?	S	CH	T	SU	Inadequate treatment	No, ulcer not caused by treatment	No
3.2	Fall > 15 m	M	UH	T	SU	Inadequate treatment	Yes, wrong treatment method	Yes
4.3	Ice hockey	S	UH	ST		Delay in treatment	No, fracture not visible in radiographs	No
4.5	Playground	S	CH	T + C		Angular deformity	Yes, angular deformity	No
4.7	Sledding	M	HC	None		Missed diagnosis	Yes, fracture missed on radiographs	Yes
5.6	Fall on level	S	UH	FIN		Pain and irritation	No, satisfactory treatment	Yes
5.7	Child abuse	S	CH	SF	Inf	Infection	Yes, unreasonable infection	No
6.9	Sledding	S	HC	None		Delay in diagnosis	Yes, no primary radiographs	Yes
7.6	Downhill skiing	S	CH	FIN		Growth plate injury	No, caused by primary injury	No
8.2	Fall 4 m	S	CH	ST	Inf	Infection	Yes, unreasonable infection	No
8.2	Sledding	S	CH	T + FIN	SU	Inadequate treatment	No, satisfactory treatment	No
8.8	Bicycle	S	UH	FIN	BI	Burn injury	Yes, inadequate use of diathermia	Yes
9.2	Downhill skiing	P	CH	C		Growth plate injury	No, caused by primary injury	No
10.2	Ice hockey	S	CH	C		Inadequate treatment	No, satisfactory treatment	No
10.2	Soccer	M	UH	SF		Pain and irritation	No, satisfactory treatment	No
11.9	Fall on level	M	CH	SF		Inadequate treatment	Yes, inproper positioning of screws	Yes
14.0	Soccer	P	CH	None		Inadequate treatment	No, satisfactory treatment	Yes
14.4	Fall on level	M	UH	SF	Inf	Infection	Yes, unreasonable infection	No
15.4	Riding	S	UH	RIN	JSD	Pain and irritation	Yes, damaging joint surface by RIN	Yes
15.4	Bicycle	S	CH	RIN		Growth disturbance	Yes, wrong treatment method	Yes
15.4	Motorcycle	S	UH	FIN		Pain and irritation	No, normal treatment	No
15.6	Motorcycle	S	CH	FIN	PA	Inadequate treatment	Yes, nail removal too early	Yes
16.8	Motorcycle	S	DH	RIN	PA	Inadequate treatment	Yes, diagnosis of PA was delayed	No

^a M: metaphysis, P: physis, S: shaft,

^b CH: central hospital, DH: district hospital, HC: healthcare center, UH: university hospital

^c C: cast, FIN: flexible intramedullary nailing, RIN: rigid intramedullary nailing, SF: screw fixation, ST: skeletal traction, T: traction

^d BI: burn injury (caused by inadequate use of diathermia), Inf: infection, JSD: joint surface damage (caused by intramedullary nailing), PA: pseudo-arthrosis, SU: skin ulcer

Table 2. The method of treatment of 1,389 childhood femoral fractures in Finland during 1997–2004 according to national registry data

Method	n
Cast immobilization in situ	142
Manipulation + cast immobilization	229
Skin traction	29
Internal fixation	762
intramedullary nail	616
screw fixation	87
plate osteosynthesis	59
Skeletal traction	143
External fixation	50
Unspecified operative treatment	0
Reoperation	14