Thirty-three patients who had been managed for an isolated, closed
fracture of the femoral shaft when they were less than seventeen years old
were examined at an average of thirty-three months (range, eighteen to
fifty-six months) after the injury. Thirteen patients (39 per cent) had a
persistent deficit in the strength of the quadriceps of the fractured limb,
as identified on testing with a Cybex-II isokinetic dynamometer. Six
patients (18 per cent) had a deficit according to the one-leg-hop for
distance test, fourteen (42 per cent) had an average loss of ten
millimeters in the circumference of the thigh, and sixteen (48 per cent)
had an average loss of 10 degrees of flexion of the knee. The etiological
factors that were thought to possibly be responsible for the weakness of
the quadriceps were evaluated. The amount of maximum displacement of the
fracture, as seen on the initial radiographs, was the only factor that was
significant for the prediction of weakness of the quadriceps (p = 0.006) at
both test speeds of the Cybex dynamometer and in all statistical analyses.
Despite the persistent weakness of the quadriceps, none of the patients had
a clinical problem at the latest follow-up examination. A subclinical
deficit in the strength of the quadriceps may be related to damage
sustained by the muscle at the time of the fracture. On the basis of the
results of this study, we do not recommend a change from the traditional
methods of treatment, which involve early application of a spica cast or
use of traction followed by application of a spica cast.