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Sheasley JA, Faino A, Gupta A, Bompadre V, Schmale GA. Advantages of a Dedicated Orthopaedic Trauma Room for Children With Fractures of the Femur Treated at a Pediatric Community Hospital. JOURNAL OF THE PEDIATRIC ORTHOPAEDIC SOCIETY OF NORTH AMERICA 2025; 10:100137. [PMID: 40433580 PMCID: PMC12088346 DOI: 10.1016/j.jposna.2024.100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 12/01/2024] [Accepted: 12/02/2024] [Indexed: 05/29/2025]
Abstract
Background The benefits of a dedicated orthopaedic trauma room (DOTR) for patients with isolated femur fractures have not been reported from a pediatric community hospital. Methods Twenty-three years of skeletally immature patients treated for an isolated diaphyseal femur fracture with two flexible intramedullary nails, Pre-DOTR: 2000-2015 and Post-DOTR: 2016-2022, were reviewed for comparison of patient demographics and injury patterns, timing and durations of surgery, fellow presence, duration and cost of hospitalization, and complication rates. Results One hundred fifty-three patients were identified. One hundred twenty-six patients underwent surgery pre-DOTR and 27 post-DOTR. Demographics were similar between groups, except the post-DOTR patients were younger (mean age 7.4 years vs 9.0 years, P = 0.002). There was no significant difference in the percentage of patients undergoing surgery within 18 h of admission pre- and post-DOTR (78% vs 93%, respectively, P = 0.53). Post-DOTR surgeries were more frequently daytime (93%) than pre-DOTR (56%, P < 0.001). Fellows were present in 8% of pre-DOTR vs 44% of post-DOTR procedures (P < 0.0001). Average durations of surgery post-DOTR were significantly longer (118 min vs 93 min, P = 0.031). Lengths of stay post-DOTR were significantly shorter (3.0 days vs 3.5 days, P = 0.016), with substantial potential cost savings. There was no significant difference in complication rates pre- and post-DOTR (21% and 22%, P = 0.85). Conclusions Implementing a guaranteed first start for orthopaedic trauma via a DOTR at a pediatric community hospital, a pediatric non-Level I or II trauma center, allowed for daytime surgery without prolonging hospital stays for pediatric patients undergoing flexible intramedullary nailing for a femur fracture. Guaranteed morning OR block time for orthopaedic trauma decreased lengths of hospital stay and enabled a larger percentage of surgeries to be done during daytime hours. Shorter hospital stays suggest substantial cost savings, while early daytime surgery for nonemergent procedures avoided burdening families with prolonged waits to surgery. Key Concepts (1)A daily dedicated orthopaedic trauma room (DOTR) for operative treatment of orthopaedic trauma in a pediatric community hospital results in the vast majority of femur fracture surgeries being performed during daytime hours.(2)Even with a delay of many femur fracture surgeries until the next morning, a DOTR does not increase the fraction of patients treated outside the 18-h window from admission.(3)A DOTR for operative treatment of pediatric femur fractures in a community pediatric hospital can decrease lengths of stay for patients treated for diaphyseal femur fractures.(4)A DOTR may decrease the costs of hospitalization by decreasing lengths of stay for patients treated for diaphyseal femur fractures. Level of Evidence Therapeutic, Level III - Retrospective comparison study.
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Affiliation(s)
| | - Anna Faino
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Apeksha Gupta
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Gregory A. Schmale
- Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, WA, USA
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Zaidman M, Simanovsky N, Goldman V, Saleem-Zedan R, Abu Jabal T, Weisstub E. Titanium Elastic Nail Fixation Versus Spica Cast Application for the Treatment of Diaphyseal Femoral Fractures in Children Under Five Years Old: A Retrospective Study. Cureus 2025; 17:e77422. [PMID: 39949426 PMCID: PMC11823280 DOI: 10.7759/cureus.77422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2025] [Indexed: 02/16/2025] Open
Abstract
Background Femoral fractures are the most common type of injury requiring hospitalization in children. Treatment for femoral shaft fractures (FSFs) in children under six years old using closed reduction and spica cast (SC) application is a widely accepted method. In our institution, we offer the option of titanium elastic nail (TEN) fixation to parents of children under five years old. This study aimed to compare the results of SC treatment and TEN fixation in children under five years of age diagnosed with FSFs. Methodology We retrospectively reviewed medical records of all children under the age of five who had FSF treated at our institution and were managed with either an SC (28 children) or TEN fixation (26 children) between 2016 and 2022. The parents made the choice of treatment following discussions with the surgical team. In our analysis, the primary outcomes focused on radiological fracture healing and alignment, time until ambulation and limb mobilization, and complications. Additionally, we compared epidemiological data, hospitalization course, caregiver satisfaction, and follow-up duration between the two groups. Results No statistically significant differences were observed in time until fracture management or duration of anesthesia between the two groups. However, in the TEN group, short-term clinical and radiological outcomes were superior (coronal angulation: 0.92° vs. 5.9°, p = 0.0018; sagittal angulation: 0.42° vs. 7.82°, p = 0.0005; femoral shortening: 0.12 vs. 1.87 cm, p < 0.0001), although the time until ambulation was longer (5.9 vs. 4.75 weeks, p < 0.0001). Caregiver satisfaction was also higher in this group (p < 0.005). Conversely, children treated with TEN fixation more frequently required strong analgesic prescriptions (90% vs. 42%, p = 0.01), underwent more radiographs (during surgery: 6.73 vs. 3.61, p < 0.0001; during follow-up- 6.42 vs. 4.3, p = 0.003), had longer-lasting follow-up (7.9 vs. 3.2 weeks, p = 0.003), had an extended hospitalization (1.8 vs. 1.2 days, p = 0.004), and needed additional procedures for TEN removal. Both methods exhibited a low complication rate. Conclusions Titanium elastic nailing can be considered a viable treatment option for FSF in children aged two to five years, offering favorable clinical and radiological outcomes, enhanced caregiver satisfaction, and a low incidence of complications.
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Affiliation(s)
- Michael Zaidman
- Department of Orthopedic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, ISR
| | - Naum Simanovsky
- Department of Orthopedic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, ISR
| | - Vladimir Goldman
- Department of Orthopedic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, ISR
| | - Reem Saleem-Zedan
- Department of Orthopedic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, ISR
| | - Taer Abu Jabal
- Department of Orthopedic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, ISR
| | - Eden Weisstub
- Department of Orthopedic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, ISR
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Liu Y, Ding S, Yang Y. Elastic stable intramedullary nail combined with Kirschner wire (E-K) technique for treating pediatric distal tibial diaphyseal metaphyseal junction (DTDMJ) fractures. Front Pediatr 2024; 12:1333652. [PMID: 38690522 PMCID: PMC11058844 DOI: 10.3389/fped.2024.1333652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/29/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE Elastic stable intramedullary nail (ESIN) is a commonly used method for treating diaphyseal fractures of the tibia, but its application in Distal Tibial Diaphyseal Metaphyseal Junction (DTDMJ) fractures has been a subject of controversy. This study aims to evaluate the clinical efficacy of the Elastic stable intramedullary nail-Kirschner wire (E-K) technique in treating pediatric DTDMJ fractures, providing better clinical decision-making for clinicians in diagnosing and treating such fractures. METHODS We conducted a retrospective analysis of patients aged 3-9 years who received treatment at our hospital from January 2019-January 2021 for distal tibial diaphyseal metaphyseal junction (DTDMJ) fractures. Based on their surgical procedures, they were categorized into the Elastic Stable Intramedullary Nail-Kirschner wire group (E-K) and the ESIN group. Demographic data, surgical duration, clinical outcomes, complications, and imaging data were recorded. RESULTS The study included a total of 57 patients, with 24 cases in the E-K group and 33 cases in the ESIN group. There were 30 males and 27 females. The average age was (6.25 ± 1.59) years in the E-K group and (6.27 ± 1.48) years in the ESIN group. There were no significant differences between the two groups in terms of gender, age, weight, time from injury to surgery, follow-up time, side of injury, associated injuries, nail site infection, deep infection, and nail removal time (P > 0.05). Neither group experienced nonunion or refracture. The E-K group exhibited significantly lower coronal and sagittal plane angular values at the final follow-up compared to the ESIN group (P < 0.001). In the E-K group, the final follow-up coronal plane angle was 2.67 (1.09)°, while in the ESIN group, it was 6.55 (2.05)°. The final follow-up sagittal plane angle was 3.12 (1.54)° in the E-K group and 7.58 (1.48)° in the ESIN group. Both groups showed good alignment in the initial postoperative x-rays, with no statistically significant differences. However, during clinical healing, the ESIN group exhibited significant displacement, whereas the E-K group had minimal displacement, demonstrating a significant statistical difference (P < 0.001). There was a statistically significant difference in the AOFAS joint function assessment between the two groups (P = 0.027). CONCLUSION The E-K technique is a viable option for treating DTDMJ fractures in pediatric patients, with well-established clinical efficacy. Its advantages include a straightforward surgical procedure, safety, and a low incidence of severe complications.
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Affiliation(s)
- Yunlong Liu
- Department of Pediatric Surgery, Ningbo Women and Children's Hospital, Ningbo, China
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Niknam K, Gatto A, Swarup I. Trends in the Management of Femur Fractures in Young Children. JOURNAL OF THE PEDIATRIC ORTHOPAEDIC SOCIETY OF NORTH AMERICA 2023; 5:766. [PMID: 40432942 PMCID: PMC12088140 DOI: 10.55275/jposna-2023-766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Indexed: 05/29/2025]
Abstract
Background: Femoral shaft fractures in young children are commonly treated with closed reduction and spica casting; however, there is increasing literature and interest focusing on internal fixation. This study aims to assess trends in the management of femoral shaft fractures in patients under the age of 6. Methods: This is a retrospective study utilizing the Pediatric Health Information System (PHIS) database. We queried for patients aged 1 to 6 years who had an isolated, closed femoral shaft fracture from October 2015 to December 2020. ICD10 procedure codes were used to determine treatment of the injury. Descriptive statistics and tests of trend were utilized in the analysis of this study. Results: We identified 4608 patients with a femoral shaft fracture during the study period. The majority of patients were treated with spica casting (n=3398, 73.7%), followed by intramedullary fixation (n=600, 13.0%) and plate osteosynthesis (n=449, 9.7%). In this cohort, 3236 patients were between the ages of 1-3 years, and 1372 patients were between the ages of 4-6 years. There was a significant difference in management between these two age groups with lower rates of spica casting in older patients (92.1% vs. 30.5%) and higher rates of intramedullary fixation (37.3% vs. 2.7%) and plate osteosynthesis (28.2% vs. 1.9%) (p<0.01). There was a significant correlation with increasing rates of intramedullary fixation and plate osteosynthesis from 2016 to 2020 (p=0.03 and 0.01, respectively), and a decrease in rate of spica casting over time (p=0.04). Conclusion: Femur fractures in young children are treated with spica casting, intramedullary nails, and plate osteosynthesis. There is a significant change in management over time, and children between the ages of 4 and 6 are more likely to be treated with intramedullary nails compared to younger children. Additional studies are needed to understand these trends as well as justify the increase in rates of intramedullary nails and plate osteosynthesis in young children. Level of Evidence: Level III; Retrospective Cohort Comparison using Large Database Key Concepts•Historically, spica casting was the gold standard for femur fracture treatment in younger patients.•There has been recent interest in the utilization of internal fixation for treatment of femur fractures in young children.•The use of intramedullary nails and plate osteosynthesis in young patients with femur fractures has increased by 34% and 25%, respectively, from 2015 to 2020.•Spica casting has remained the main treatment option for patients aged 1-3.•Intramedullary nails and plate osteosynthesis have been used increasingly over time for patients aged 4-6.
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Affiliation(s)
- Kian Niknam
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Andrew Gatto
- California College of Osteopathic Medicine, Touro University, Vallejo, CA
| | - Ishaan Swarup
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA
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Sanjay N, Seenappa H, Shanthappa AH, Kumar K V. Functional Outcome of Pediatric Subtrochanteric Fractures Treated With a Titanium Elastic Nailing System (TENS) Versus Plating. Cureus 2023; 15:e40036. [PMID: 37425582 PMCID: PMC10324435 DOI: 10.7759/cureus.40036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Uncertainty exists regarding the ideal course of therapy for subtrochanteric fractures in children of intermediate age. These fractures are challenging to treat, with scarce literature-based evidence to support a definitive implant. The ideal course of treatment should consider the patient's weight, age, femoral canal size, associated injuries, fracture stability, and surgeon's experience. A subtrochanteric femoral fracture in a child between the age of 5-12 is difficult to treat. For these patients, there is debate concerning the optimal internal fixation, hence this study was conducted to try and determine the superior mode of treatment for these fractures. The objective of this study is to compare functional outcomes of subtrochanteric fractures in the paediatric age group operated on with titanium elastic nail and plate fixation and the complications associated with both treatment modalities. Materials and methods This is a retrospective observational study of 40 cases that were admitted and operated on in the hospital of the current study from May 2007 to November 2021. Twenty patients underwent titanium elastic nailing system (TENS) nailing and the other 20 patients underwent plating for subtrochanteric fractures. The surgeries were conducted at our institute and patients were followed up at one-, three-, and six-month intervals. The final functional results were calculated with the help of the Flynn scoring system. Results Out of 40 patients involved in the present study, 17 were female while 23 were male. Twenty patients received treatment with titanium elastic nails, and the remaining twenty received plating. The majority of the patients were males around 9.6 years of age on average in the plating group and 8.9 years in the nailing group. In comparison to 75% of participants in the plating group, 40% of patients who received nailing showed excellent results. Results were satisfactory for five patients who received titanium elastic nails and one who received plating. The only poor outcomes were noticed in six people (30%) in TENS and three people (15%) in the plating group who went through unplanned surgery for complications. In comparison to the plating group, the overall rate of complication was much greater in the TENS group. Conclusion We would like to conclude our study that, in accordance with Flynn's score, both elastic nailing and plating stabilization can produce positive functional outcomes. Both groups have a similar percentage of excellent and good results. We also conclude that the overall complication rate is slightly higher for patients treated with TENS when compared to plating for subtrochanteric fractures.
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Affiliation(s)
- Nandini Sanjay
- Department of Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Hariprasad Seenappa
- Department of Orthopaedics, Sri Devaraj Urs Academy Of Higher Education and Research, Kolar, IND
| | - Arun H Shanthappa
- Department of Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Vinod Kumar K
- Department of Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
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Outcomes and complications following flexible intramedullary nailing for the treatment of tibial fractures in children: a meta-analysis. Arch Orthop Trauma Surg 2022; 142:1469-1482. [PMID: 33635402 DOI: 10.1007/s00402-021-03839-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Tibial shaft fractures are common occurrence in children and surgical treatment is sometimes required, particularly in unstable or open fractures, and in polytrauma. The aim of this study was to investigate the available evidence on the efficacy and safety of flexible intramedullary nailing (FIN) for both open and closed tibia fractures in children, exploring the main surgical outcomes and rate of complications. MATERIALS AND METHODS Pubmed/Medline, Scopus and Cochrane Central databases were searched following the PRISMA guideline. Studies reporting on the outcomes of FIN for paediatric tibia shaft fractures were included. Weighted means were evaluated for surgical outcomes. Meta-analysis of proportion and odd ratios were used to analyse total complication rates and differences between open and closed fractures. RESULTS Twenty-eight studies (835 patients) were included; the mean age was 11.0 ± 3.0 years. The mean follow-up was 22.5 ± 13.5 months; the mean time to full weight-bearing was 7.5 ± 3.7 weeks. The total complication rate was 28.1% (minor = 20.7%, major = 6.3%); this was greater in open fractures (13.6% vs 5.1%, p = 0.007). The rate of union was 97.5%, with a mean time to union of 11.9 ± 7.2 weeks. Malunion was found in 8.5% cases, delayed union in 3.8%, non-union in 1.4%, symptomatic hardware in 5.1%, leg-length discrepancy in 5.0%, superficial infections in 2.3%, deep infections in 1.0%, compartment syndromes in 1.4%, and refracture in 0.2%. Almost all patients returned to unrestricted physical activity. CONCLUSIONS FIN offers excellent outcomes for the treatment of paediatric tibia shaft fractures. Patients presenting with an open fracture have a higher but acceptable complication rate. Comparative studies are needed to clarify if other treatments have superior outcomes.
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Shieh AK, Saiz Jr AM, Hideshima KS, Haus BM, Leshikar HB. Defining length stability in paediatric femoral shaft fractures treated with titanium elastic nails. J Child Orthop 2021; 15:525-531. [PMID: 34987661 PMCID: PMC8670542 DOI: 10.1302/1863-2548.15.210081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/30/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Optimal paediatric femoral shaft fracture patterns or lengths amenable to titanium elastic nail stabilization have not been well defined. The purpose of this study is to identify radiographic parameters predictive of treatment failure with flexible intramedullary nails based upon fracture morphology. METHODS A retrospective review was performed of all femoral shaft fractures treated with flexible intramedullary nails over a five-year period. All patients with at least six weeks of postoperative radiographic imaging were included. Fracture characteristics included location, pattern, length, obliquity, angulation, translation and shortening. Postoperative radiographs were reviewed to determine shortening and angulation. RESULTS There were 58 patients with 60 femoral shaft fractures stabilized with titanium nails, with 46 healing within acceptable parameters and 14 considered malunions. Six of the 14 malunions developed complications requiring early unplanned intervention. No patients in the treatment success group had a complication. Between the treatment success and failure groups, fracture pattern, location, length, obliquity, angulation, translation or shortening were not statistically different. Mean nail canal fill was significantly lower in the failure group (0.72 versus 0.81; p = 0.0146), with a receiver operating characteristic curve identifying canal fill 76% as the optimal threshold. CONCLUSION This is the first study to measure the length and obliquity of paediatric femoral shaft fractures and to determine their relationship to radiographic alignment after healing. None of the preoperative fracture characteristics were predictive of malalignment or shortening. We recommend the use of larger nail sizes in the treatment of paediatric femoral shaft fractures, especially if there is concern for residual instability. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alvin K. Shieh
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, California, United States
| | - Augustine M. Saiz Jr
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, California, United States
| | - Kelsey S. Hideshima
- School of Medicine, University of California Davis Medical Center, Sacramento, California, United States
| | - Brian M. Haus
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, California, United States
| | - Holly B. Leshikar
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, California, United States,Correspondence should be sent to Holly B. Leshikar, University of California Davis Medical Center, Department of Orthopaedic Surgery, 4860 Y Street, Suite 3800, Sacramento, CA 95817, United States. E-mail:
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Rigid intramedullary nail fixation of traumatic femoral fractures in the skeletally immature. OTA Int 2021; 4:e128. [PMID: 34746660 PMCID: PMC8568442 DOI: 10.1097/oi9.0000000000000128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 12/02/2020] [Accepted: 03/14/2021] [Indexed: 11/26/2022]
Abstract
Objective To determine the rate of femoral head osteonecrosis, and other complications following rigid intramedullary (IM) nail fixation of traumatic diaphyseal femur fractures through the greater trochanter in the skeletally immature. Design Retrospective review, case series. Setting Level I academic trauma center. Patients/Participants One hundred forty-eight traumatic pediatric diaphyseal femur fractures in 145 patients treated with rigid IM nail fixation from November 1, 2004 to December 31, 2018. Intervention Rigid intramedullary nail fixation of traumatic diaphyseal femur fractures through a trochanteric start point in the skeletally immature. Main outcome measurement Rate of osteonecrosis of the femoral head. Results Sixty-five fractures in 64 skeletally immature patients met inclusion criteria. Motor vehicle collisions were implicated in 32 fractures. Of the 65 fractures, 5 were open. All rigid IM nails were anterograde with a trochanteric start point. Mean radiographic follow-up was 27.4 ± 8.1 months. Twenty-two patients experienced postoperative pain and/or hardware irritation, with 24 patients (36.9%) undergoing reoperation for hardware removal. No occurrences of infection, malunion, nonunion, refracture, venous thromboembolism, fat embolism, significant leg length discrepancy, or femoral head osteonecrosis were documented. Two cases of heterotopic ossification were observed, 1 requiring surgical excision, yielding a complication rate of 3.1%. Conclusions No cases of femoral head osteonecrosis were observed following treatment of 65 traumatic diaphyseal femur fractures with rigid IM nailing through the greater trochanter with a mean radiographic follow-up of 27 months. Rigid IM nail fixation with a trochanteric start point is both safe and efficacious for management of diaphyseal femur fractures in the skeletally immature.
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Zhu D, Xu X, Zhang M, Wang T. Titanium elastic nailing can be used in 6 to 10 years old pediatric with Delbet IV femoral neck fractures. Medicine (Baltimore) 2021; 100:e27588. [PMID: 34713834 PMCID: PMC8556016 DOI: 10.1097/md.0000000000027588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 10/02/2021] [Indexed: 01/05/2023] Open
Abstract
The purpose of this study was to analyze the outcomes of titanium elastic nail (TEN) for the children in 6 to 10 years old who sustained a Delbet IV femoral neck fracture.A total of 56 children aged 6 to 10 years old with Delbet IV femoral neck fracture treated with TEN or cannulated screw (SC) were identified at our hospital from January 2009 to December 2019. Of which 24 were treated with TEN, and 32 with SC. All of them were followed up for 1 year after operation, and the differences in operation time, intraoperative blood loss, hospitalization time, hip joint function, and complication between the 2 groups were compared. Harris and Ratliff hip score were used to evaluate the hip function.All 56 fractures united properly. No major complications were noted in both groups. The intraoperative blood loss and operation time in TEN group and SC group were (11.42 ± 3.41) mL, (19.66 ± 4.05) mL (P = .000) and (33.58 ± 7.89) min, (40.22 ± 7.48) min (P = .002), respectively. There was no significant statistical difference between hip regarding range of motion and femoral neck-shaft angle in both groups, as well as Harris and Ratliff hip score between the 2 groups.TEN represent safe and effective methods in the treatment of Delbet IV femoral neck fracture in 6 to 10 years old children. TEN internal fixation is a minimal invasive and simpler technique and suitable for young children of Delbet IV femoral neck fracture.
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Shah FA, Ali MA, Naeemullah. Outcome of proximal femur shaft fractures in school going children treated with locking compression plates. Pak J Med Sci 2021; 37:1353-1358. [PMID: 34475911 PMCID: PMC8377903 DOI: 10.12669/pjms.37.5.3938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/14/2021] [Accepted: 04/30/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To determine the clinical and radiological outcome of proximal femur shaft fractures in school going children treated with locking compression plates (LCP). METHODS This descriptive study was conducted in Orthopaedic Division Lady Ready Reading Hospital Peshawar from 25th June 2018 to 25th September 2020. Children of either gender and age 6 to 12 years old with subtrochanteric and proximal one third femur factures fulfilling the inclusion criteria were enrolled in this study. Open reduction and internal fixation with 4.5 mm narrow locking compression plates (LCP) were done in all. Post operative clinical outcome was evaluated by using Flynn scoring system and graded as excellent, satisfactory and poo results. Radiological assessment of fracture union was done through anteroposterior (AP) and lateral X-ray radiographs. RESULTS A total of 60 children with mean age 9.01±1.61 SD (range 6 to 12 years) were included in our study. Oblique fractures were present in 23(38.3%) children, spiral in 20(33.3%), transverse in 11(18.3%) and comminuted in 6 (10%) children. The radiological union time was 13.3±1.2 weeks (range 9.4 to 18 weeks). Majority (88.3%, n=53) of children had excellent clinical outcome according to Flynn's scoring system while satisfactory outcome was noted in 7(11.6%) children. No cases of delayed union, mal union, nonunion and implant failure was reported. CONCLUSION The results of our study indicated that proximal femoral shaft fractures in school going children treated with locking compression plates had excellent clinical and radiological outcome. We therefore recommend locking compression plate as the implant of choice to fix proximal femoral shaft fractures in school going children.
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Affiliation(s)
- Faaiz Ali Shah
- Dr. Faaiz Ali Shah, FCPS. Department of Orthopaedics & Traumatology, Lady Reading Hospital, Peshawar, Pakistan
| | - Mian Amjad Ali
- Dr. Mian Amjad Ali, PhD. Department of Orthopaedics & Traumatology, Lady Reading Hospital, Peshawar, Pakistan
| | - Naeemullah
- Dr. Naeemullah, FCPS. Department of Orthopaedics & Traumatology, Lady Reading Hospital, Peshawar, Pakistan
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van Cruchten S, Warmerdam EC, Kempink DRJ, de Ridder VA. Treatment of closed femoral shaft fractures in children aged 2-10 years: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2021; 48:3409-3427. [PMID: 34338819 PMCID: PMC9532337 DOI: 10.1007/s00068-021-01752-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/18/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To review current literature on treatment of closed femoral shaft fractures in children of 2-10 years old, with subgroup analysis of children aged 2-6 years, comparing intramedullary nailing (IMN) to conservative treatment modalities. METHODS We included clinical trials and observational studies that compared traction and subsequent casting (TSC), spica casting and IMN for treatment of femur shaft fractures in children of 2-10 years of age. Subgroup analysis of children aged 2-6 years was performed. RESULTS Compared to treatment with immediate spica casting, IMN led to significantly less coronal angulation (mean difference (MD): 2.03 degrees, confidence interval (CI) 1.15-2.90), less sagittal angulation (MD: 1.59 degrees, CI 0.82-2.35) and lower rates of LLD (Risk difference (RD): 0.07, CI 0.03-0.11). In terms of rehabilitation, IMN leaded to shorter time until walking with aids (MD: 31.53 days, CI 16.02-47.03), shorter time until independent ambulation (MD: 26.59 days, CI 22.07, 31.11) and shorter time until full weight bearing (MD: 27.05 days, CI 6.11, 47,99). Compared to TSC, IMN led to a lower rate of malunion (RD: 0.31, CI 0.05-0.56), shorter hospital stays (MD: 12.48 days, CI 11.57, 13.39), time until walking with aids (MD: 54.55, CI 40.05-69.04) and full weight bearing (MD: 27.05 days [6.11, 47,99]). CONCLUSION Although a lack of quality evidence, this systematic review showed a clear tendency to treatment with elastic intramedullary nails of femoral shaft fractures in children of 2-10 years of age. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Stijn van Cruchten
- UMC Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- , Kromme Nieuwegracht 15, 3512 HC, Utrecht, The Netherlands.
| | - Eefke C Warmerdam
- Reinier Haga Orthopedisch Centrum, Toneellaan 2, 2725 NA, Zoetermeer, The Netherlands
| | - Dagmar R J Kempink
- Erasmus MC/Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
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Kim TG, Park MS, Lee SH, Choi KJ, Im BE, Kim DY, Sung KH. Leg-length discrepancy and associated risk factors after paediatric femur shaft fracture: a multicentre study. J Child Orthop 2021; 15:215-222. [PMID: 34211597 PMCID: PMC8223087 DOI: 10.1302/1863-2548.15.200252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE This study was performed to investigate leg-length discrepancy (LLD) and associated risk factors after paediatric femur shaft fractures. METHODS A total of 72 consecutive patients under 13 years old (mean age 6.7 years; 48 boys, 24 girls) with unilateral femur shaft fracture, and a minimum follow-up of 18 months, were included. The amount of LLD was calculated by subtracting the length of the uninjured from that of the injured limb. Risk factors for an LLD ≥ 1 cm and ≥ 2 cm were analyzed using multivariable logistic regression analysis. RESULTS Hip spica casting, titanium elastic nailing and plating were performed on 22, 40 and ten patients, respectively. The mean LLD was 7.8 mm (sd 8.8) and 29 (40.3%) had a LLD of ≥ 1 cm, while nine (12.5%) had a LLD of ≥ 2 cm. There were significant differences in fracture stability (p = 0.005) and treatment methods (p = 0.011) between patients with LLD < 1 cm and ≥ 1 cm. There were significant differences in fracture site shortening (p < 0.001) and LLD (p < 0.001) between patients with length-stable and length-unstable fractures. Fracture stability was the only factor associated with LLD ≥ 1 cm (odds ratio of 4.0; p = 0.020) in the multivariable analysis. CONCLUSION This study demonstrated that fracture stability was significantly associated with LLD after paediatric femur shaft fractures. Therefore, the surgeon should consider the possibility of LLD after length-stable femur shaft fracture in children. LEVEL OF EVIDENCE Prognostic level III.
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Affiliation(s)
- Tae Gyun Kim
- Department of Orthopaedic Surgery, Konyang University Hospital, Daejeon, Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, Korea,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Hyeong Lee
- Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital, Gyeonggi, Korea
| | - Kug Jin Choi
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, Korea
| | - Byeong-eun Im
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, Korea
| | - Dae Yeung Kim
- Department of Orthopaedic Surgery, Konyang University Hospital, Daejeon, Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, Korea,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea,Correspondence should be sent to: Ki Kyuk Sung, Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi 13620, Korea. E-mail:
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Naik P. Remodelling in Children's Fractures and Limits of Acceptability. Indian J Orthop 2021; 55:549-559. [PMID: 33995859 PMCID: PMC8081818 DOI: 10.1007/s43465-020-00320-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/20/2020] [Indexed: 02/04/2023]
Abstract
Remodeling follows inflammatory and reparative phases of bone healing and is very pronounced in children. Unlike adults, in growing children, remodeling can restore the alignment of initially malunited fractures to a certain extent, making anatomic reduction less essential. Remodeling is not universal and ubiquitous. Animal experiments and clinical studies have proven that in a malunited fracture, the angulation corrects maximally by physeal realignment (75%) and partly by appositional remodeling of the diaphysis also known as the cortical drift (25%). Remodeling potential reduces with the increasing age of the child; lower extremities have higher remodeling potential compared to the upper extremity. Remodeling is most pronounced at the growing end of the bone and in the axis of the adjacent joint motion. Correction of a very small amount of rotational malalignment is possible, but it is clinically not relevant. Overgrowth of the bone after a fracture occurs due to hyperaemia of fracture healing. Overgrowth is the most common after paediatric femur fractures, though it is reported after fractures of the tibia and humerus as well. The orthopaedic surgeon treating children's fractures should be familiar with regional variations of remodeling and limits of acceptance of angulation in different regions. Acceptability criteria for different bones are though well defined, but serve best as guidelines only. For the final decision-making patient's functional capacity, parents' willingness to wait until the completion of the remodeling process, and the experience of treating doctor should be considered concurrently. In case of the slightest doubt, a more aggressive approach should be taken to achieve a satisfactory result.
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Affiliation(s)
- Premal Naik
- Rainbow Super-Speciality Hospital and Children’s Orthopaedic Centre, Next to Asia School, Behind HDFC Bank, Opposite Drive in Cinema, Bodakdev, Ahmedabad, Gujarat 380 054 India
- Honorary Pediatric Orthopedic Surgeon, Smt S C L Hospital, NHL Municipal Medical College, Ahmedabad, Gujarat India
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The clinical features, management options and complications of paediatric femoral fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:883-892. [PMID: 33839930 PMCID: PMC8233277 DOI: 10.1007/s00590-021-02933-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/08/2021] [Indexed: 10/27/2022]
Abstract
This article discusses the incidence, applied anatomy and classification of paediatric femoral fractures based on critical appraisal of the available evidence. The aim is to identify techniques that are relevant to contemporary practice whilst excluding the technical details of individual procedures that are beyond the scope of this review. Injuries of the proximal, diaphyseal and distal segments are considered individually as there are considerations that are specific to each anatomical site. Femoral neck fractures are rare injuries and require prompt anatomical reduction and stable fixation to minimise the potentially devastating consequences of avascular necrosis. Diaphyseal fractures are relatively common, and there is a spectrum of management options that depend on patient age and size. Distal femoral fractures often involve the physis, which contributes up to 70% of femoral length. Growth arrest is common consequence of fractures in this region, resulting in angular and length-related deformity. Long-term surveillance is recommended to identify deformity in evolution and provide an opportunity for early intervention. Deliberate injury should be considered in all fractures, particularly distal femoral physeal injuries and fractures in the non-walking child.
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Lakhani A, Bhatnagar SM, Singh GP, Gupta N, Sharma E. Role of mini-invasive bridge plate in the complex femoral fracture in school going children: A prospective clinical study of 30 cases. J Family Med Prim Care 2021; 10:1188-1192. [PMID: 34041149 PMCID: PMC8140261 DOI: 10.4103/jfmpc.jfmpc_1210_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 12/02/2022] Open
Abstract
Objective: Pediatric femoral fracture including supracondylar and subtrochanteric fracture constitutes 1.6% of all paediatric fracture. Elastic nails remain the standard treatment of choice in a midshaft transverse femoral fracture in children weighing less than 45 kg. But in subtrochanteric and spiral femoral fracture, the failure rate of elastic nails are quite high. Hence, in accordance with AAOS guidelines, we treated complex femoral fracture in children with submuscular mini-invasive bridge plate because of its advantage of minimal incision, early union with proper alignment and lower failure. Material and Methods: We retrospectively reviewed 30 complex femur fracture in children treated with Submuscular bridge plate by mini-invasive approach. Patients were analysed according to their age, type of fracture, time of union in weeks, complication and results were evaluated with modified Flynn's criteria. Result: Out of 30 patients 28 were boys and 2 were females, with an average age of 11.5 years in which Spiral fracture (n = 12), subtrochanteric fracture (n = 9), Complex Shaft fracture (n = 10). All fracture united well on an average of 11 weeks. And 29 patients has excellent results and in 1 patient there is Acceptable result. The single complication was 3 mm limb lengthening but it didn't change gait of the patient. Conclusion: Mini invasive bridge plating is an easy and soft tissue preserving procedure for managing complex femoral fracture in children. It has shown promising results in achieving union without any major complication. We strongly recommend the SBP in a complex femoral fracture in children.
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Affiliation(s)
- Amit Lakhani
- Department of Orthopedics, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti Solan, Mullana, Ambala, Haryana, India
| | - S M Bhatnagar
- Department of Orthopedics, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti Solan, Mullana, Ambala, Haryana, India
| | - Gobind Pratap Singh
- Department of Orthopedics, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti Solan, Mullana, Ambala, Haryana, India
| | - Nikunj Gupta
- Department of Orthopedics, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti Solan, Mullana, Ambala, Haryana, India
| | - Ena Sharma
- Department of Periodontics, Maharishi Markandeshwar College of Dental Sciences and Research, Mullana, Ambala, Haryana, India
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Yaokreh JB, Sounkéré-Soro M, Tembely S, Kouamé YGS, Thomas AH, Odéhouri-Koudou TH, Kouamé BD, Ouattara O. Compared outcomes of femoral shaft fracture treatment in school-age children in Sub-Saharan Africa: Primary open reduction and intramedullary K-wire fixation versus traction followed by spica cast. Afr J Paediatr Surg 2021; 18:79-84. [PMID: 33642403 PMCID: PMC8232366 DOI: 10.4103/ajps.ajps_35_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Elastic stable intramedullary nailing has become the treatment of choice for femur shaft fractures in school-age children in developed world. However, in the sub-Saharan Africa, this management is still challenging because of the lack of fluoroscopy in more hospitals. We performed either primary open reduction and intramedullary K-wire fixation (PORIKF) or conservative treatment. The aim of this study was to compare the clinical and functional outcomes of these two procedures employed. PATIENTS AND METHODS This retrospective study included 62 children with 64 fractures (10 years on an average; range: 6-15 years) treating for femoral shaft fractures either by PORIKF (n = 21; 23 fractures) or skin traction followed by spica cast (n = 41) between 2008 and 2017. Outcomes were assessed using Flynn criteria. Comparisons were made by Fisher and Student's t-test with a significant P < 5%. RESULTS Outcomes were satisfactory in 21 cases (91%) in the PORIKF group compared with 32 (78%) in the conservative group (P = 0.3012). The average hospital stay was 18.6 days in the PORIKF group, whereas it was 20 in the conservative group (P = 0.0601). The mean time for bone union was 13.9 weeks in the PORIKF group and 13.2 weeks in the conservative group, (P = 0.4346). There was a statistically significant difference between the two groups in terms of major complications (P = 0.0177). One patient had osteomyelitis in the PORIKF group. Unacceptable shortening >2 cm was observed only in the conservative group. The average time to return to daily activities was 30 days shorter in the PORIKF group when compared to conservative group (P < 0.05). CONCLUSION PORIKF provides better results than conservative treatment. Open reduction did not increase the rate of infectious complication.
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Affiliation(s)
| | | | - Samba Tembely
- Department of Pediatric Surgery, CHU Yopougon, Abidjan 21, Côte d'Ivoire
| | | | | | - Thierry-Hervé Odéhouri-Koudou
- Department of Pediatric Surgery; Emergency Department of Medicine and Surgery, CHU Yopougon. 21 P.O.Box 632 Abidjan 21, Côte d'Ivoire
| | - Bertin Dibi Kouamé
- Department of Pediatric Surgery, CHU Yopougon, Abidjan 21, Côte d'Ivoire
| | - Ossénou Ouattara
- Department of Pediatric Surgery, CHU Yopougon, Abidjan 21, Côte d'Ivoire
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Miyamoto S, Otsuka M, Hasue F, Fujiyoshi T, Kamiya K, Kiuchi H, Odagiri T, Tanaka T, Nakamura J, Orita S, Ohtori S. Associated injury complicated by pediatric lower limb shaft fractures and clinical efficacy of flexible stainless-steel intramedullary nailing in children less than 15 years old. Orthop Rev (Pavia) 2021; 13:8008. [PMID: 33897986 PMCID: PMC8054656 DOI: 10.4081/or.2021.8008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/05/2021] [Indexed: 11/23/2022] Open
Abstract
Although pediatric lower limb shaft fractures are common, little is known about associated injuries. The purpose of this study was to examine associated injuries complicated by pediatric lower limb shaft fractures and the efficacy of surgical treatment using a flexible stainless-steel intramedullary Ender nail in children less than 15 years old. This is a retrospective review of 29 children younger than 15 years old who were diagnosed with femoral or tibial shaft fractures and treated using Ender nails from 2005 to 2016. Baseline data, etiology, associated injuries, fracture site and patterns, operative and post-operative assessment were evaluated. The average age of the patients was 9.0 years, and mean follow-up was 18.2 months. Eleven patients (79%) had associated injury. At the final follow up, six patients (43%) sustained complications associated with the insertion area of the nail. There was no evidence of deep infection or nonunion at either fracture site. The clinical results were excellent in 10 (67%) fractures, and good in 5 (33%) fractures, based on the modified Flynn criteria. Almost all patients with a femoral fracture had an associated injury including abdominal visceral injury, cerebral contusion or other fractures. This study indicated good clinical and functional outcomes. On the other hand, the minor complications rate was high. Nevertheless, elastic stable intramedullary nailing recently has become available in Japan, and a prospective and comparative study is needed.
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Affiliation(s)
| | | | - Fumio Hasue
- Kimitsu Central Hospital, Kisarazu City, Chiba
| | | | | | | | | | | | - Junichi Nakamura
- Graduate School of Medicine, Chiba University, Chiba City, Chiba
| | - Sumihisa Orita
- Center for Advanced Joint Function and Reconstructive Spine Surgery Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Graduate School of Medicine, Chiba University, Chiba City, Chiba
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Liau GZQ, Lin HY, Wang Y, Nistala KRY, Cheong CK, Hui JHP. Pediatric Femoral Shaft Fracture: An Age-Based Treatment Algorithm. Indian J Orthop 2020; 55:55-67. [PMID: 33569099 PMCID: PMC7851225 DOI: 10.1007/s43465-020-00281-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/29/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Fractures of the femoral shaft in children are common. The rates of bone growth and remodeling in children vary according to their ages, which affect their respective management. METHODS This paper evaluates the incidence and patterns of pediatric femoral shaft fracture and the current concepts of treatments available. RESULTS The type of fracture-closed or open; stable or unstable-needs to be taken into account. Child abuse should be suspected in fractures sustained by infants. For younger children, non-surgical management is preferred, which include Pavlik harness (< 6 months old) and early spica casting (6 months to 6 years old). Older children (> 6 years old) usually benefit from surgical treatments as outcomes of non-surgical alternatives are worse and are associated with prolonged recovery times. These operative measures for older children that are 6-12 years old include elastic stable intramedullary nailing and submuscular plating. Factors to be considered when devising an appropriate intervention include body mass, location of injury, and nature of fracture. For adolescent and skeletally mature teenagers (> 12 years old), rigid antegrade entry intramedullary fixation is indicated. In the event of open fractures or polytrauma, external fixation should be considered as a temporary treatment method for initial fracture stabilization. CONCLUSION An age-based and evidence-based algorithm has been proposed to guide surgeons in the process of evaluating an appropriate treatment.
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Affiliation(s)
- Glen Zi Qiang Liau
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System, 1E Lower Kent Ridge Road, Singapore, 119228 Singapore
| | - Hong Yi Lin
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Yuhang Wang
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | | | | | - James Hoi Po Hui
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System, 1E Lower Kent Ridge Road, Singapore, 119228 Singapore
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
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Mussell EA, Jardaly A, Gilbert SR. Length unstable femoral fractures: A misnomer? World J Orthop 2020; 11:380-390. [PMID: 32999858 PMCID: PMC7507079 DOI: 10.5312/wjo.v11.i9.380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/28/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Flexible intramedullary nailing (FIMN) is relatively contraindicated for pediatric length unstable femoral fractures.
AIM To evaluate FIMN treatment outcomes for pediatric diaphyseal length unstable femoral fractures in patients aged 5 to 13 years.
METHODS This retrospective study includes pediatric patients (age range 5-13 years) who received operative treatment for a diaphyseal femoral fracture at a single institution between 2013 and 2019. Length unstable femur fractures treated with FIMN were compared to treatment with other fixation methods [locked intramedullary nailing (IMN), submuscular plating (SMP), and external fixation] and to length stable fractures treated with FIMN. Exclusion criteria included patients who had an underlying predisposition for fractures (e.g., pathologic fractures or osteogenesis imperfecta), polytrauma necessitating intensive care unit care and/or extensive management of other injuries, incomplete records, or no follow-up visits. Patients who had a length stable femoral fracture treated with modalities other than FIMN were excluded as well.
RESULTS Ninety-five fractures from ninety-two patients were included in the study and consists of three groups. These three groups are length unstable fractures treated with FIMN (n = 21), length stable fractures treated with FIMN (n = 45), and length unstable fractures treated with either locked IMN, SMP, or external fixator (n = 29). P values < 0.05 were considered statistically significant. Patient characteristic differences that were statistically significant between the groups, length unstable with FIMN and length unstable with locked IMN, SMP, or external fixator, were average age (7.4 years vs 9.3 years, respectively), estimated blood loss (29.2 mL vs 98 mL, respectively) and body mass (27.8 kg vs 35.1 kg, respectively). All other patient characteristic differences were statistically insignificant. Regarding complications, length unstable with FIMN had 9 total complications while length unstable with locked IMN, SMP, or external fixator had 10. Grouping these complications into minor or major, length unstable with locked IMN, SMP, or external fixator had 6 major complication while length unstable with FIMN had 0 major complications. This difference in major complications was statistically significant. Lastly, when comparing patient characteristics between the groups, length unstable with FIMN and length stable with FIMN, all characteristics were statistically similar except time to weight bearing (39 d vs 29 d respectively). When analyzing complication differences between these two groups (9 total complications, 0 major vs 20 total complications, 4 major), the complication rates were considered statistically similar.
CONCLUSION FIMN is effective for length unstable fractures, having a low rate of complications. FIMN is a suitable option for length stable and length unstable femur fractures alike.
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Affiliation(s)
- Eric Andrew Mussell
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, and Andrews Sports Medicine and Orthopaedic Center, Birmingham, AL 35205, United States
| | - Achraf Jardaly
- Department of Orthopedic Surgery, University of Alabama at Birmingham and Lebanese American University, Gilbert and Rose-Marie Chagoury School of Medicine, Byblos 00000, Lebanon
| | - Shawn R Gilbert
- Department of Pediatric Orthopaedics, University of Alabama at Birmingham, Birmingham, AL 35233, United States
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Ulici A, Odagiu E, Haram O, Ionescu A, Sterian GA, Carp M, Tevanov I. Poor prognostic factors of femoral shaft fractures in children treated by elastic intramedullary nailing. SICOT J 2020; 6:34. [PMID: 32870156 PMCID: PMC7461699 DOI: 10.1051/sicotj/2020031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/11/2020] [Indexed: 11/14/2022] Open
Abstract
Introduction: Femoral shaft fractures in pediatric patients are treated by elastic intramedullary nailing using titanium or stainless-steel nails. The elastic stable intramedullary nailing behaves as an internal splint, promoting early mobilization. This type of treatment involves a minimally invasive approach, no damage to the growth plates, and no impairment of femoral head blood supply. Purpose: The aim of our study was to identify the negative predicting factors that might lead to an increased complication rate after elastic stable intramedullary nailing of femoral shaft fractures in children. Methods: We conducted a retrospective study on 137 patients with femoral shaft fractures treated by elastic stable intramedullary nailing. Patients’ age ranged between 4 and 17 years. We used data from the medical records of the patients to evaluate postoperative complications. Plain radiographs were analyzed to determine the fracture type, fracture location, and postoperative complications such as delayed union, angular deformities, and limb length discrepancies. Multivariate analysis was conducted to identify predictors for poor outcomes. Results: Complications occurred in 29 patients (21%) and consisted of delayed union, axial deformities, or lower limb length discrepancies. In the group of patients that suffered from complications, mechanism of injury, age, and weight were significant. They were older by an average of 5 years; half of them weighed more than 50 kg and over a half were involved in a road traffic accident. Conclusions: Elastic nailing is a successful tool to treat femoral shaft fractures. Three factors were demonstrated to influence the outcome. The mechanism of injury, age > 11 years, and weight > 50 kg are the most important and are predictors for development of complications such as delayed union or deformity.
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Affiliation(s)
- Alexandru Ulici
- Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", 30-32 Iancu de Hunedoara Blvd., 011733 Bucharest, Romania - "Carol Davila" University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, București 050474, Romania
| | - Elena Odagiu
- Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", 30-32 Iancu de Hunedoara Blvd., 011733 Bucharest, Romania
| | - Oana Haram
- Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", 30-32 Iancu de Hunedoara Blvd., 011733 Bucharest, Romania
| | - Adelina Ionescu
- Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", 30-32 Iancu de Hunedoara Blvd., 011733 Bucharest, Romania
| | - Gabriel Alin Sterian
- Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", 30-32 Iancu de Hunedoara Blvd., 011733 Bucharest, Romania - "Carol Davila" University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, București 050474, Romania
| | - Madalina Carp
- Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", 30-32 Iancu de Hunedoara Blvd., 011733 Bucharest, Romania
| | - Iulia Tevanov
- Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", 30-32 Iancu de Hunedoara Blvd., 011733 Bucharest, Romania
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21
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Marson BA, Craxford S, Deshmukh SR, Grindlay D, Manning J, Ollivere BJ. Outcomes reported in trials of childhood fractures: a systematic review. Bone Jt Open 2020; 1:167-174. [PMID: 33225285 PMCID: PMC7677094 DOI: 10.1302/2633-1462.15.bjo-2020-0031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aims To analyze outcomes reported in trials of childhood fractures. Methods OVID MEDLINE, Embase, and Cochrane CENTRAL databases were searched on the eighth August 2019. A manual search of trial registries, bibliographic review and internet search was used to identify additional studies. 11,476 studies were screened following PRISMA guidelines. 100 trials were included in the analysis. Data extraction was completed by two researchers for each trial. Study quality was not evaluated. Outcomes reported by trials were mapped onto domains in the World Health Organization (WHO) International Classification of Function framework. Results In all, 525 outcomes were identified representing 52 WHO domains. Four domains were reported in more than 50% of trials: structure of upper/lower limb, sensation of pain, mobility of joint function, and health services, systems and policies. The Activities Scale for Kids performance (ASK-p) score was the most common outcome score reported in 6/72 upper limb and 4/28 lower limb trials. Conclusion There is a diverse range of outcomes reported in trials of childhood fractures covering all areas in the International Classification of Functioning, Disability and Health (ICF) framework. There were three common upper limb and three common lower limb outcomes. In the absence of a core outcome set, we recommend that upper limb trials report pain, range of movement and radiograph appearance of the arm and lower limb trials report pain, radiograph appearance of the leg and healthcare costs to improve consistency of reporting in future trials. Cite this article: Bone Joint Open 2020;1-5:167–174.
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Affiliation(s)
- Ben A Marson
- Trauma Outcomes Group, University of Nottingham, Queens' Medical Centre, Nottingham, UK
| | - Simon Craxford
- Trauma Outcomes Group, University of Nottingham, Queens' Medical Centre, Nottingham, UK
| | - Sandeep R Deshmukh
- Trauma Outcomes Group, University of Nottingham, Queens' Medical Centre, Nottingham, UK
| | - Douglas Grindlay
- Trauma Outcomes Group, University of Nottingham, Queens' Medical Centre, Nottingham, UK
| | - Joseph Manning
- School of Health Sciences, University of Nottingham; Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust Queens' Medical Centre, Nottingham, UK
| | - Benjamin J Ollivere
- Trauma Outcomes Group, University of Nottingham, Queens' Medical Centre, Nottingham, UK
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Yigit Ş, Yıldırım A. The surgery outcomes of pediatric femoral shaft fractures and comparision of radiation risks. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:326-331. [PMID: 32420969 PMCID: PMC7569624 DOI: 10.23750/abm.v91i2.8709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/24/2019] [Indexed: 12/02/2022]
Abstract
INTRODUCTION To show midterm results and compare the two methods utilized in pediatric femoral diaphysis fractures fixation and the risks of radiation. METHODS We conducted retrospective studies of 60 children and adolescent between the age of 6 to 16 years who were exposed to traumatic femoral shaft fractures and treated with methods of fixation titanyum elastic nail (EN), submuscular bridge plating (SBP) Twenty eight (18 males and 10 females) were treated with SBP (group 1), and 32 patients (18 males and 14 females) were treated with EN (group 2). RESULTS The mean age of the patients was 10,3 years. Duration of follow-up was 29.8 months. Mean union time was 7,4 weeks (range, 6-10 weeks). Operative time was on average 60.6 minutes. Considering Flynn's criteria, the results of treatment was excellent in 50, good in 4 and poor in 6 cases. CONCLUSIONS In the surgical treatment of pediatric femoral shaft fractures, fixation techniques such as submuscular bridge platingand elastic nails were found to have similar fracture healing and complication rates. An orthopaedic surgeon must protect himself, his personnel and the patient from radiation exposure. Open reduction internal plate fixation can be chosen as an alternative treatment for children who do not cause radiation exposure to the femoral fracture.
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Milligan D, Henderson L, Tucker A, Ballard J. Elastic nail fixation versus plate fixation of paediatric femoral fractures in school age patients - A retrospective observational study. J Orthop 2020; 19:153-157. [PMID: 32025124 PMCID: PMC6997651 DOI: 10.1016/j.jor.2019.11.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/24/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The management of paediatric femoral fractures continues to spark debate in published literature, with poor quality evidence guiding current guidelines on the optimum treatment in children. Many centres report excellent results for both elastic intramedullary nailing and plate fixation of diaphyseal femoral fractures. This study aimed to investigate the outcomes of femoral fractures treated with elastic nail fixation versus those treated with plate fixation in a tertiary children's trauma unit, and discuss the advantages and disadvantages of each technique. MATERIALS AND METHODS A retrospective review of all femoral fractures undergoing fixation at a level one paeditric trauma and tertiary referral unit, between 1st April 2009 and 30th April 2017, was performed.Clinical notes and radiographs were reviewed to determine patient demographics and injury, operative and hospital stay data. Radiological union, defined as bridging callus present on at least three out of four cortices on orthogonal radiographs, was determined at 12 weeks. Outcomes were determined using the Flynn Criteria. Patients were followed up for a minimum of 2 years. Data was statistically analysed, and a p value < 0.05 was considered significant. RESULTS There were a total of 28 patients- 14 in each treatment group. Patients undergoing elastic nail fixation were significantly older than plate fixation (9.7 ± 1.9 Vs 7.7 ± 1.8; p = 0.008). A male preponderance was noted (21/28), with no difference between groups (10 Vs 11; p = 1.00). Plate fixation demonstrated a tendency towards shorter length of stay (6.3 ± 2.1 Vs 7.8 ± 3.0; p = 0.134), earlier radiological union at 12 weeks (14 Vs 10; p = 0.098), lower postoperative analgesia requirements (0.82 ± 0.45 Vs 1.12 ± 0.97; p = 0.200), and better outcomes, as determined by the Flynn criteria. CONCLUSIONS In the authors opinion, plate fixation is a safe, effective alternative to elastic nail fixation with equivocal outcomes as determined by the Flynn Criteria. Plate fixation may offer advantages in shorter length of stay, reduced postoperative pain and earlier weightbearing. Further large scale, prospective research is required to determine whether these are borne out in practice.
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Affiliation(s)
- D. Milligan
- C/O Fracture Clinic, Royal Belfast Hospital for Sick Children, Falls Road, Belfast, Northern Ireland, BT12 6BE, UK
| | - L. Henderson
- C/O Fracture Clinic, Royal Belfast Hospital for Sick Children, Falls Road, Belfast, Northern Ireland, BT12 6BE, UK
| | - A. Tucker
- C/O Fracture Clinic, Royal Belfast Hospital for Sick Children, Falls Road, Belfast, Northern Ireland, BT12 6BE, UK
| | - J. Ballard
- Royal Belfast Hospital for Sick Children, Falls Road, Belfast, Northern Ireland, BT12 6BE, UK
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Khuntia S, Swaroop S, Patro BP, Sahu S. Paediatric Long Bone Fractures Managed with Elastic Intramedullary Nails: A Retrospective Study of 30 Patients. Cureus 2020; 12:e7847. [PMID: 32483498 PMCID: PMC7253075 DOI: 10.7759/cureus.7847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/27/2020] [Indexed: 01/15/2023] Open
Abstract
Elastic intramedullary nailing or titanium elastic nail (TEN) is an alternative method for the treatment of various pediatric long bone fractures. Titanium nails are preferred over plaster cast and stainless steel nails for children older than six years. Our series included 30 paediatric long bone fractures who were managed with TEN. The mean age was 9.3 years and the mean follow-up period was 28 months. A mean time of 10 weeks was recorded for the union of all fractures. The occurrence of superficial infection in three cases healed with antibiotics and minor debridement. Limb length discrepancy was seen in three cases of femur fracture, which was functionally insignificant, but it may be a potential problem needing close follow-up until skeletal maturity is attained. An elastic intramedullary nail or TEN in long bone fractures in children is a safe and minimally invasive technique that achieves stable reduction, especially in long spiral fractures till union. We attained successful union and good results in all our 30 cases with long bone fractures in children. A few complications of hardware prominence were resolved with implant removal. Long-term studies with a comparison to casting techniques in paediatric long bone fractures are required.
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Affiliation(s)
- Susanta Khuntia
- Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Shakti Swaroop
- Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Bishnu P Patro
- Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Subhrajyoti Sahu
- Microbiology, Maharaja Krishna Chandra Gajapati (MKCG) Medical College, Berhampur, IND
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Siddiqui AA, Illingworth KD, Abousamra OA, Meisel EM, Kay RM. Femoral shaft fractures in children with non-ambulatory neuromuscular disorders can be effectively treated using flexible intramedullary nails. J Child Orthop 2020; 14:132-138. [PMID: 32351626 PMCID: PMC7184642 DOI: 10.1302/1863-2548.14.190154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE There is little information in the literature regarding flexible intramedullary nails (FIN) for treating femur fractures in children with neuromuscular disorders. The purpose of this study is to investigate the outcomes of FIN for femoral shaft fractures in non-ambulatory children with neuromuscular disorders. METHODS A retrospective review was conducted on patients with femur fractures at a paediatric hospital between 2004 and 2018. Inclusion criteria were femoral shaft fracture treated with FIN. Outcomes were compared between patients with neuromuscular disorders (NM group) and a control group of those without neuromuscular disorders. RESULTS A total of 37 patients with 37 femoral shaft fractures were studied (12 patients in the NM group and 25 in the control group). All NM group patients were non-ambulatory at baseline. Fractures were length stable in all 25 patients in the control group and in 2/12 (17%) patients in the NM group. All fractures healed in both groups. Three complications (all nail migrations) requiring reoperation before fracture union occurred in the NM group, yielding a major complication rate of 25% (3/12) in the NM group versus 0% (0/25) in controls (p = 0.03). Angular deformity occurred in 5/12 (42%) NM group patients and 1/25 (4%) control group patient (p = 0.009); none required reoperation. CONCLUSION Femur fractures in non-ambulatory children with neuromuscular disorders can be successfully treated with FIN. Angular deformities are common in this population, but had no functional impact in the non-ambulatory NM group patients. Surgeons must also be vigilant for implant prominence and skin breakdown in these patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ali A. Siddiqui
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, USA,Keck School of Medicine of University of Southern California, USA
| | - Kenneth D. Illingworth
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, USA,Keck School of Medicine of University of Southern California, USA
| | - Oussama A. Abousamra
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, USA,Keck School of Medicine of University of Southern California, USA
| | - Erin M. Meisel
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, USA,Keck School of Medicine of University of Southern California, USA
| | - Robert M. Kay
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, USA,Keck School of Medicine of University of Southern California, USA,Correspondence should be sent to Robert M. Kay, Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA 90027, USA. E-mail:
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Alberghina F, Andreacchio A, Cravino M, Paonessa M, Canavese F. Extra-articular proximal femur fractures in children and adolescents treated by elastic stable intramedullary nailing. INTERNATIONAL ORTHOPAEDICS 2019; 43:2849-2856. [PMID: 31352564 DOI: 10.1007/s00264-019-04379-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Extra-articular proximal femur fractures (EPFF) remain challenging for their intrinsic instability. The aim of this study is to evaluate the results of elastic stable intramedullary nailing (ESIN) of extra-articular proximal femur fractures in children and adolescents. METHODS A retrospective monocentric study of children treated by ESIN for EPFF between 2012 and 2018 was conducted. We included all patients sustaining a fracture within 10% of the femur length below the lesser trochanter. Studied data were age, sex, femur length, fracture distance below the lesser trochanter, number of days of hospitalization, time to nail removal, and complications. Beaty's criteria and the titanium elastic nailing (TEN) outcome measure scale were used to evaluate radiologic outcome and assess clinical recovery, respectively. RESULTS A total of 24 cases were reviewed (18 males, 6 females). Mean age was 8.23 years (range 5-13). Mean duration of hospitalization was 3.7 days (range 2-12). Mean time to nail removal was 28 weeks (range 12-53). Malalignment was observed in five patients, but in all cases, angulation did not exceed 10°. No limb length discrepancy was observed. Twenty out of 24 patients had excellent Beaty's radiological and TEN clinical outcome scores. No poor results were observed. CONCLUSIONS The results of our study show that good outcomes following surgical treatment by ESIN should be expected in children younger than 14 years of age with displaced EPFF. Excellent radiological and clinical outcomes were observed in 83.7% of the cases, with a low rate of complications and short hospital stay.
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Affiliation(s)
- Flavia Alberghina
- Pediatric Orthopedic Surgery Department, "Regina Margherita" Children's Hospital, Piazza Polonia 94, 10100, Torino, Italy
| | - Antonio Andreacchio
- Pediatric Orthopedic Surgery Department, "Regina Margherita" Children's Hospital, Piazza Polonia 94, 10100, Torino, Italy.
| | - Mattia Cravino
- Pediatric Orthopedic Surgery Department, "Regina Margherita" Children's Hospital, Piazza Polonia 94, 10100, Torino, Italy
| | - Matteo Paonessa
- Pediatric Orthopedic Surgery Department, "Regina Margherita" Children's Hospital, Piazza Polonia 94, 10100, Torino, Italy
| | - Federico Canavese
- Pediatric Surgery Department, University Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont Ferrand, France
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Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails. ACTA ACUST UNITED AC 2019; 55:medicina55060266. [PMID: 31185694 PMCID: PMC6630376 DOI: 10.3390/medicina55060266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/25/2019] [Accepted: 06/08/2019] [Indexed: 01/29/2023]
Abstract
Background and objectives: Pediatric tibial shaft fractures often have satisfactory outcomes after closed reduction and casting. However, surgical treatment may be required in unstable or open fractures. Titanium elastic nails (TENs) are a good option for the surgical treatment of pediatric tibial fractures due to their advantages such as short hospitalization periods, easy applicability, early weight bearing, and early union. In this study, we evaluated radiological and functional outcomes in pediatric patients with tibial shaft fractures that underwent fixation with TENs. Materials and methods: A total of twenty tibial shaft fractures that were treated with TENs in our clinic between 2013 and 2017 were retrospectively reviewed. The mean age at injury was 8.9 ± 2.78 (range of 3–14) years. Seven (35%) out of 20 fractures were open fractures, of which one fracture was classified as Grade I and six fractures were classified as Grade II. In each patient, antegrade nailing was performed by inserting a TEN in the medial and another TEN in the lateral side of the proximal metaphysis. Clinical outcomes including union, alignment, leg-length inequality, and complications were evaluated using modified Flynn’s criteria. Results: The mean time to union was 10.85 ± 3.39 (range of 6–20) weeks. No patient had a sagittal or coronal angulation of over 10°. One patient had a leg-length inequality of 10 mm. Among three patients with open fractures, two of them had superficial wound infections and the other patient had a deep wound infection. All the infections were successfully treated with appropriate antibiotic therapies. Four other patients had pin tract irritation that required no intervention. No significant difference was observed between patients with open and closed fractures with regard to the clinical and radiological findings although patients with open fractures had a significantly higher complication rate compared to patients with closed fractures (p < 0.05). No patient had a restricted range of motion of the ankle and knee joints. Twelve (60%) patients had an excellent outcome, and eight (40%) patients had a satisfactory outcome. Conclusions: Intramedullary fixation with TENs provides favorable outcomes and reduced complication rates in the treatment of unstable pediatric tibial shaft fractures that cannot be reduced with conservative treatment modalities or cannot be casted due to the presence of an edema or open wound.
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Debuka E, Kushwaha NS, Kumar D, Singh A, Sharma V. Rust score-An adequate rehabilitation guide for diaphyseal femur fractures managed by TENS. J Clin Orthop Trauma 2019; 10:922-927. [PMID: 31528069 PMCID: PMC6738353 DOI: 10.1016/j.jcot.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/18/2018] [Accepted: 06/26/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The optimal mode of treatment among the wide variety of surgical and nonsurgical treatment options for children between 5 and 15 years of age continues to be controversial. Elastic stable intramedullary nailing of long bone fractures in the skeletally immature has gained widespread popularity because of its clinical effectiveness and low risk of complications. METHODS AND METHODOLOGY From Jan 2015 to August 2016, 35 patients including 37 limbs with diaphyseal fractures of the femur in the age group 5-15 years were managed by Titanium Elastic nailing and their clinico-radiological and functional outcome was assessed at 1 year post operatively as per the Flynn's criteria. RUST score was used as a guide for post-operative rehabilitation. RESULTS 37 patients were managed by TENS nailing including 28 males and 9 females. The outcome in proximal, middle or distal fractures of the shaft were found to be similar and the difference was statistically insignificant. Similarly, the difference in the outcomes as per fracture patterns was also found to be statistically insignificant. Partial weight bearing was allowed after a score of 6 was achieved and full weight bearing after a score of 8. CONCLUSION As per the Flynn's criteria, 75% of the patients (28 out of 37) were found to have an excellent outcome while 7 had a satisfactory outcome and two had a poor outcome. RUST score can be used as an effective guide for post op rehabilitation.
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Kayaokay K, Aktuglu K. Titanium elastic nailing in pediatric femoral diaphyseal fractures in the age group of 6-15 years mid-term and long-term outcomes. Pak J Med Sci 2018; 34:1529-1533. [PMID: 30559817 PMCID: PMC6290206 DOI: 10.12669/pjms.346.16297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To evaluate the effectiveness of Titanium Elastic Nailing (TEN) used in the surgical treatment of pediatric femoral shaft fractures and the effect of the complications to the outcome. Another objective was to assess the changing of Limb Length Discrepancy (LLD) and angulation degree with prolonged follow-up time and to evaluate whether the patient had a functional problem because of this situation. Methods: Thirty children between the ages of 6 and 15 who had femur shaft fractures were evaluated. The times of operation, ambulation, bone union and follow-up were recorded. Post-operative complications were evaluated between 1996-2016 with at least 24 Months follow up. Results: The mean follow-up was 52.5 ± 49.0 months (range 24-240). The mean varus angulation was 3.2 ± 5.1 degrees. The length of the fracture side was approximately 0.71 ± 0.58 cm (range 0-2.09 cm) longer than the intact side. There were eight patients with LLD of 1-2 cm. There was no statistically significant relationship between the type, location, and age of fracture of the LLD (P> 0.05). It was evaluated according to Flynn’s criteria. According to this, 12 (40%) of the patients’ results were excellent, 14 (46.7%) were good, and four were poor. Conclusion: TEN is an effective, easy, fast treatment method and has minimal complications for the treatment of femoral shaft fractures in childhood. Most complications can be reduced by performing basic principles and technical directions. Although LLD is a common complication of childhood femur fractures, the disease does not present a functional problem in daily life.
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Affiliation(s)
- Kemal Kayaokay
- Dr. Kemal Kayaokay, Department of Orthopaedics and Traumatology, Siverek State Hospital, Sanliurfa, Turkey
| | - Kemal Aktuglu
- Dr. Kemal Aktuglu, Department of Orthopaedics and Traumatology, Ege University Hospital, 35070 Bornova-Izmir, Turkey
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Chen LK, Sullivan BT, Sponseller PD. Submuscular plates versus flexible nails in preadolescent diaphyseal femur fractures. J Child Orthop 2018; 12:488-492. [PMID: 30294373 PMCID: PMC6169557 DOI: 10.1302/1863-2548.12.180036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To compare patient characteristics, operative time, estimated blood loss (EBL), postoperative length of hospital stay (LOS) and complications after insertion and removal of submuscular plates (SMPs) versus flexible nails (FNs) for paediatric diaphyseal femur fractures. METHODS We reviewed records of 58 children (mean age, 7.7 years SD 2.0) with diaphyseal femur fractures who underwent treatment with SMPs (n = 30) or FNs (n = 28) from 2005 to 2017 (mean follow-up, 22 months SD 28). Patients with pathological fractures or musculoskeletal comorbidities were excluded. Alpha = 0.05. RESULTS Insertion of FNs was associated with shorter operative time (ß = -24 mins) and less EBL (ß = -38 mL) (both, p < 0.001) compared with insertion of SMPs, after adjusting for fracture type and time from beginning of study period. Removal of FNs was also associated with shorter operative time (ß = -15 min) compared with removal of SMPs (p < 0.001). EBL during removal was similar between groups (p = 0.080). The FN group had a shorter LOS after insertion (ß = -0.2 d) compared with the SMP group (p = 0.032). Four patients treated with SMPs and three treated with FNs developed surgical site infections. Two patients treated with SMPs and seven treated with FNs experienced implant irritation that resolved with removal. No other complications occurred. CONCLUSION Compared with SMPs, FNs were associated with shorter operative time (for insertion and removal), less EBL (for insertion) and shorter post-insertion LOS in patients with diaphyseal femur fractures. LEVEL OF EVIDENCE III.
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Affiliation(s)
- L.-K. Chen
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
| | - B. T. Sullivan
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
| | - P. D. Sponseller
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA, Correspondence should be sent to P. D. Sponseller, Johns Hopkins Children’s Center, 1800 Orleans Street, 7359A, Baltimore, Maryland 21287, United States. E-mail:
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Xu Y, Bian J, Shen K, Xue B. Titanium elastic nailing versus locking compression plating in school-aged pediatric subtrochanteric femur fractures. Medicine (Baltimore) 2018; 97:e11568. [PMID: 30024559 PMCID: PMC6086543 DOI: 10.1097/md.0000000000011568] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The treatment of children between 5 and 12 years of age suffering from subtrochanteric femoral fracture is challenging. The optimal choice of internal fixation for these patients is controversial. The purpose of this study is to compare the outcomes and complications of titanium elastic nail and open reduction with plate fixation of subtrochanteric femur fractures in school-aged children.A total of 67 children aged 5 to 12 years with subtrochanteric femur fractures treated with titanium elastic nails or open plating were identified at our institution from January 2007 to December 2017. We retrospectively compared 39 children treated with titanium elastic nails with 28 children treated with open reduction and plate fixation. The data included age, sex, body weight, fracture pattern, operation time, blood loss, and length of hospitalization. The follow-up investigations included radiograph of pelvis, bilateral hip range of motion, bilateral femoral neck shaft angle, and length of lower extremity. The outcomes were classified according to Flynn classification as excellent, satisfactory, or poor. All the demographic characteristics were compared with statistical analyses.All 67 fractures united properly. No major postoperative complications were noted in both groups. No significant difference was found between the titanium elastic nail and open plating groups in terms of sex, fracture pattern, and length of hospitalization. We noted a significant difference between 2 groups in terms of age, weight, operation time, and blood loss. In total, we observed 24 excellent and 15 satisfactory results in the titanium elastic nail group, and 19 excellent results and 9 satisfactory results in the open plating group. There was no significant statistical difference between involved and uninvolved side of hip regarding range of motion and femoral neck shaft angle in both groups.Titanium elastic nail and pediatric hip plate fixation represent safe and effective methods in the treatment of subtrochanteric fractures in school-aged children. Titanium elastic nail internal fixation is a minimal invasive and simpler technique and suitable for young children of lower body weight. Open plate fixation is a more rigid fixation associated with a lower complication rate.
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Affiliation(s)
| | | | | | - Bin Xue
- Department of Anesthesiology, Shanghai Children's Medical Center, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Kawalkar A, Badole C. Percutaneous titanium elastic nail for femoral shaft fracture in patient between 5 and 15 years. J Orthop 2018; 15:695-700. [PMID: 29881223 PMCID: PMC5990292 DOI: 10.1016/j.jor.2018.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/06/2018] [Indexed: 10/17/2022] Open
Abstract
Femoral shaft fracture is the commonest major pediatric orthopedic injury requiring hospitalization. Controversy persists regarding management of femoral fractures in the patients aged between 5-15 years. 11 patients were followed up for the mean period of 12 months and evaluated using Flynn's criteria. All the fractures united between 8-12 weeks. 3 patients had knee stiffness, 1 patient had shortening > 2 cm and 1 had superficial infection. We conclude that TENs is simple, rapid & effective treatment for displaced pediatric femoral shaft fractures between 5-15 years of age with very less complication rate.
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Affiliation(s)
| | - C.M. Badole
- Department of Orthopaedics, MGIMS, Sewagram, India
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Reddy A, Pushpasekaran N, Singh J, Verma GC, Palanisamy S. Do demographic and perioperative parameters really affect the final outcomes of pediatric femur shaft fractures managed by elastic nails? A prospective study. J Orthop 2018; 15:186-189. [PMID: 29657465 DOI: 10.1016/j.jor.2018.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 09/07/2017] [Accepted: 01/12/2018] [Indexed: 10/18/2022] Open
Abstract
Objective Pediatric femoral shaft fractures are more commonly treated with intramedullary titanium elastic nail system (TENS). Adhering to the principles, most studies had supported excellent results with this instrumentation and attributed the variation in age, weight, immobilization protocols, technical factors like fracture pattern, reduction and complications as reasons to poor outcomes in their individual studies. Hence, we wanted to identify the potential demographic and perioperative parameters that could affect the final outcomes in this cohort. Methods A prospective (level III) study done in a single center between November 2013 and January 2017 on isolated closed femoral shaft fractures in patients of age between 6 and 15 years managed with TENS. The demographic and perioperative parameters were recorded. The patients were followed up regularly with plain radiographs. The final outcomes were computed at end of one year and recorded as poor, satisfactory and excellent as defined by Flynn criteria. Results Among the thirty patients included, mean age was 8.2 years. 80% of the patients weighing over 40 kg had satisfactory to poor outcomes. (p = 0.005). 45% of patients with proximal and distal level fractures that were long oblique spiral or comminuted types had satisfactory outcomes; however it was not statistically significant. The mean delay to surgical fixation was 5.87 days, surgical time was between 45 and 150 min and open reduction was required in about 17 cases (57%). Patients with immobilization beyond 6 weeks had satisfactory outcomes (p = 0.001). We had 5 patients with minor complications (4 bursitis and 3 superficial infections) and one major complication (chronic osteomyelitis and deep venous thrombosis) leading to satisfactory and poor outcomes respectively. Significant osseous union was noted between 6 and 11 months with 97% of patients attaining union within 9 months. Conclusions Intramedullary TENS is an excellent modality to treat femoral shaft fractures in patients of school going age. However, factors like weight of the patient >40 kg, immobilization beyond 6 weeks, minor and major complications in the perioperative period could pose risks for poor to satisfactory outcomes and should be anticipated and explained accordingly.
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Affiliation(s)
- Abhinandhan Reddy
- Department of Orthopaedics, Dr. Baba Saheb Ambedkar Hospital, New Delhi, 110085, India
| | | | - Jitendra Singh
- Department of Orthopaedics, Dr. Baba Saheb Ambedkar Hospital, New Delhi, 110085, India
| | - Gokul Chand Verma
- Department of Orthopaedics, Dr. Baba Saheb Ambedkar Hospital, New Delhi, 110085, India
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Predictive factors determining outcomes in pulseless limb in paediatric supracondylar fractures of humerus. J Clin Orthop Trauma 2018; 9:S92-S96. [PMID: 29628707 PMCID: PMC5883919 DOI: 10.1016/j.jcot.2017.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/05/2017] [Accepted: 10/21/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Amongst all the complications associated with paediatric supracondylar humerus fractures, significant vascular injury is reported in only 1% cases, of which, less than 1% develop Volkmann's ischemic contracture. This study evaluates factors, like delay in presentation of the injury, limb perfusion and pulse, in determining functional outcome in a supracondylar humerus fractures with pulseless limb. MATERIALS & METHODS Twenty-one paediatric patients with a pulseless supracondylar humerus fracture presenting from 2012 to 2014 were included. The patients were divided into 3 groups with Group A (pulse returned post-reduction, n = 13), Group B (pink pulseless hand, n = 7) and Group C (white pulseless hand, n = 1). 11 patients in group A and 4 patients in Group B presented within 6 h. of injury while the remaining patients presented after 6 h. The primary outcome was vascular status as indicated by radial pulse and perfusion, and secondary outcomes included functional parameters assessed with Mayo Elbow Performance Score and Flynn criteria. RESULTS Mean peripheral SpO2 in Group A patients was higher than Group B and Group C had a non-recordable oxygen saturation. Mean capillary refill time was more in Group A than Group B whereas in Group C patient had blanching and no capillary refill was seen. Mean Mayo Elbow Performance Score of Group A patients was highest as compared to Group B and Group C. Patients presenting within 6 h. of injury had a higher mean Mayo Elbow Performance score as compared to the patients presenting after 6 h of injury. Functional outcome as measured by Flynn Criteria was excellent in 13 patients. 6 patients had a good, 2 had fair outcome. A moderate negative corrélation (R = -0.5798) was seen between the time elapsed from the injury and the Mayo Elbow Performance score. CONCLUSION Duration to presentation since injury, limb perfusion and presence of peripheral pulses seem to be important predictive factors determining the outcomes in pulseless supracondylar fracture humerus.
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Nielsen E, Bonsu N, Andras LM, Goldstein RY. The effect of canal fill on paediatric femur fractures treated with titanium elastic nails. J Child Orthop 2018; 12:15-19. [PMID: 29456749 PMCID: PMC5813120 DOI: 10.1302/1863-2548.12.170083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Traditional teaching for fixation of paediatric femur fractures recommends 80% nail diameter/medullary canal diameter ratio (ND/MCD) for successful maintenance of reduction. Prior studies have investigated this with stainless steel Enders nails. Our aim was to assess the impact of ND/MCD on maintenance of reduction and malunion rates in paediatric femur fractures treated with flexible intramedullary nails (FINs). METHODS Retrospective data was collected on all paediatric patients treated with FINs for diaphyseal femur fractures at a single tertiary care institution over a ten-year period. Patients with co-morbidities affecting bone quality were excluded. Patients were subdivided into groups based on ND/MCD. RESULTS A total of 66 patients met inclusion criteria. Mean ND/MCD was 76.3% (32.9% to 98.8%, SD 14.3). In all, 50% (n = 33/66) of patients had > 80% ND/MCD, and only 13.6% (n = 9/66) of patients had less than 60% ND/MCD. When controlling for fracture stability, ND/MCD had no correlation with mean shortening (p = 0.07) There was no correlation between ND/MCD and angulation in the sagittal (p = 0.96) or coronal plane (p = 0.20). Three patients fit malunion criteria. ND/MCD for these patients were 40%, 67% and 79%. CONCLUSION There was no correlation between ND/MCD and shortening or malangulation. The majority of patients in this series with less than 80% fill with FIN healed within acceptable parameters. LEVEL OF EVIDENCE III.
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Affiliation(s)
- E. Nielsen
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - N. Bonsu
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - L. M. Andras
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - R. Y. Goldstein
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA,
Correspondence should be sent to R. Goldstein, Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA 90027, United States. E-mail:
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Dey S, Mishra K, Nagda TV, Dhamele J, Rathod C, Dey D. Titanium Elastic Nailing with Temporary External Fixator versus Bridge Plating in Comminuted Pediatric Femoral Shaft Fractures: A Comparative Study. Indian J Orthop 2018; 52:507-512. [PMID: 30237608 PMCID: PMC6142807 DOI: 10.4103/ortho.ijortho_304_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND High-velocity trauma, associated injuries, risk of iatrogenic devascularization of fragments and need for maintaining alignment upto union make comminuted fracture in pediatric femur a formidable fracture to treat. This comparative study was conducted to evaluate the outcomes of two modes of management in such cases: titanium elastic nailing supplemented with external fixator and submuscular bridge plating (BP). MATERIALS AND METHODS Thirty eight children (aged 6-12 years) with comminuted fracture shaft femur who were randomized into two groups underwent systematic evaluation. One group was operated with titanium nailing with temporary external stabilization by fixators (titanium nailing with external [TNE] group) for 4 weeks. The other underwent submuscular BP with locked plates (BP group). Clinical and radiological outcomes, operative time, blood loss, radiation exposure, difficulties in removal and complications were evaluated. RESULTS Both groups achieved union (10.7 ± 1.9 weeks BP, 11 ± 1.6 weeks TNE), satisfactory knee flexion (138.2 ± 6.4° BP, 136 ± 7.3° TNE), and painless weight bearing (7.3 ± 0.9 weeks vs. 7.3 ± 1.4 weeks) in acceptable alignment. Functional outcomes were excellent in majority of both BP (15 of 19) and nail external fixator groups (15 of 18). Operating time and radiation exposure (69.5 ± 14.5 s vs. 50.9 ± 12.9 s) were more in TNE than in BP (P < 0.01). However, implant removal was more difficult in BP (56.4 ± 12.4 min in BP vs. 30.1 ± 8.8 min TNE). Pin-tract infections (n = 3) and hardware prominence (n = 2) in TNE group and deep infections (n = 2) in BP group were notable complications. CONCLUSION Two groups were similar in radiological and functional outcomes. Inserting elastic nails and external fixator was a more exacting surgery, while removal was more difficult in BP group. Both techniques had acceptable success and complication rates.
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Affiliation(s)
- Sukalyan Dey
- Department of Orthopaedics, Gauhati Medical College and Hospital, Guwahati, Assam, India,Address for correspondence: Dr. Sukalyan Dey, Department of Orthopaedics, Gauhati Medical College and Hospital, Guwahati, Assam, India. E-mail:
| | - Kartikey Mishra
- Department of Orthopaedics, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | | | - Jaideep Dhamele
- Institute of Paediatric Orthopaedic Disorders, Mumbai, Maharashtra, India
| | - Chasanal Rathod
- Institute of Paediatric Orthopaedic Disorders, Mumbai, Maharashtra, India
| | - Dipa Dey
- Department of Physical Medicine and Rehabilitation, College of Physiotherapy and Medical Sciences, Guwahati, Assam, India
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Nielsen E, Andras LM, Bonsu N, Goldstein RY. The effects of body mass index on treatment of paediatric femur fractures managed with flexible intramedullary nails. J Child Orthop 2017; 11:393-397. [PMID: 29081855 PMCID: PMC5643934 DOI: 10.1302/1863-2548.11.170084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Traditionally, flexible intramedullary nails (FINs) are not to be used to fix femur fractures in patients > 50 kg (110 lbs). However, studies have not examined the efficacy of this technique in overweight and obese patients who may be under this 'weight cutoff'. The purpose of this study was to assess how patient body mass index (BMI) impacts the treatment of paediatric femur fractures managed with FINs. METHODS Retrospective data was collected on all paediatric patients treated with FINs for diaphyseal femur fractures at a single tertiary care institution over a ten-year period. BMI was calculated and categorised according to the Centre for Disease Control BMI Calculator for Children and Teens. Patients with comorbidities affecting bone quality were excluded. RESULTS A total of 54 patients met inclusion criteria. In all, 14 patients were underweight, 20 were within a normal weight range, and 20 were overweight/obese. There was no correlation between BMI and mean shortening (underweight: 7.1 mm, normal weight: 5.2 mm, overweight/obese: 7.2 mm; p = 0.55). There was no correlation between BMI and mean anterior/posterior angulation (underweight: 3.1°, normal weight: 3.8°, overweight/obese: 3.3°; p = 0.93). There was no correlation between BMI and varus/valgus angulation (underweight: -0.86°, normal weight: -0.5°, overweight/obese: -1.25°; p = 0.89). Three cases fit malunion criteria. One of these patients fell into the 'underweight' category and two patients fell into the 'normal weight' category. CONCLUSION We found no association between BMI and malunion in FIN fixation of femoral diaphyseal fractures in children. All cases of malunion were seen in underweight or normal weight patients.
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Affiliation(s)
- E. Nielsen
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - L. M. Andras
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - N. Bonsu
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - R. Y. Goldstein
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, California, USA.,Correspondence should be sent to Dr Rachel Y. Goldstein, Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, California 90027, United States. E-mail:
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Anari JB, Neuwirth AL, Horn BD, Baldwin KD. Ipsilateral femur and tibia fractures in pediatric patients: A systematic review. World J Orthop 2017; 8:638-643. [PMID: 28875130 PMCID: PMC5565496 DOI: 10.5312/wjo.v8.i8.638] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/25/2017] [Accepted: 03/24/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To better understand how pediatric floating knee injuries are managed after the wide spread use of new orthopaedic technology.
METHODS We searched EMBASE, COCHRANE and MEDLINE computerized literature databases from the earliest date available in the databases to February 2017 using the following search term including variants and pleural counterparts: Pediatric floating knee. All studies were thoroughly reviewed by multiple authors. Reference lists from all articles were scrutinized to identify any additional studies of interest. A final database of individual patients was assembled from the literature. Univariate and multivariate statistical tests were applied to the assembled database to assess differences in outcomes.
RESULTS The English language literature contains series with a total of 97 pediatric patients who sustained floating knee injuries. Patients averaged 9.3 years of age and were mostly male (73). Approximately 25% of the fractures were open injuries, more tibia (27) than femur (10). Over 75% of the fractures of both the tibia and the femur involved the diaphysis. More than half (52) of the patients were treated non-operatively for both fractures. As a sequela of the injury 32 (33%) patients were left with a limb length discrepancy, 24 (25%) patients had lengthening of the injured limb at follow up, while 8 (8%) had shortening of the affected limb. Infection developed in 9 patients and 3 had premature physeal closure. Younger patients were more likely to be treated non-operatively (P < 0.001) and patients treated with operative intervention had statistically significant shorter hospital length of stays (P = 0.001).
CONCLUSION Given the predominance of non-operative management in published studies, the available literature is not clinically relevant since the popularization of internal fixation for pediatric long-bone fractures
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John R, Sharma S, Raj GN, Singh J, C. V, RHH A, Khurana A. Current Concepts in Paediatric Femoral Shaft Fractures. Open Orthop J 2017; 11:353-368. [PMID: 28603567 PMCID: PMC5447924 DOI: 10.2174/1874325001711010353] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 07/09/2016] [Accepted: 07/15/2016] [Indexed: 12/12/2022] Open
Abstract
Pediatric femoral shaft fractures account for less than 2% of all fractures in children. However, these are the most common pediatric fractures necessitating hospitalization and are associated with prolonged hospital stay, prolonged immobilization and impose a significant burden on the healthcare system as well as caregivers. In this paper, the authors present a comprehensive review of epidemiology, aetiology, classification and managemement options of pediatric femoral shaft fractures.
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Affiliation(s)
- Rakesh John
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Siddhartha Sharma
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gopinathan Nirmal Raj
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jujhar Singh
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Varsha C.
- Department of Paediatrics, Indraprastha Apollo Hospital, New Delhi, India
| | - Arjun RHH
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankit Khurana
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Shen K, Xu Y, Cao D, Wang Z, Cai H. Outcome of antegrade intramedullary fixation for juvenile fifth metacarpal neck fracture with titanium elastic nail. Exp Ther Med 2017; 13:2997-3002. [PMID: 28587371 DOI: 10.3892/etm.2017.4369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/01/2017] [Indexed: 11/05/2022] Open
Abstract
The purpose of the current study was to assess the outcome of antegrade intramedullary fixation with titanium elastic nail (TEN) in displaced fifth metacarpal neck fractures. The present study included 69 consecutive juvenile patients with displaced fifth metacarpal fractures. The head-shaft angle of the fifth metacarpal and range of motion (ROM) of the metacarpophalangeal (MCP) joint were evaluated. A disabilities of the arm, shoulder and hand (DASH) questionnaire was used to assess upper arm function. The head-shaft angle of the affected side was significantly improved postoperatively (P<0.05). No marked difference was observed between the affected and unaffected side in head-shaft angle and ROM. The average DASH score was 1.7 (range, 0-6.0). All patients obtained anatomical reduction postoperatively and the average healing time was 5.7±1.09 weeks (range, 5-10 weeks) with no non-union cases. Therefore antegrade intramedullary fixation with TEN is recommended as an easy, reliable and minimally invasive surgical technique for treating displaced fifth metacarpal neck fractures.
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Affiliation(s)
- Kaiying Shen
- Department of Pediatric Orthopedics, Shanghai Children's Medical Center, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Yunlan Xu
- Department of Pediatric Orthopedics, Shanghai Children's Medical Center, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Dan Cao
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200030, P.R. China
| | - Zhigang Wang
- Department of Pediatric Orthopedics, Shanghai Children's Medical Center, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Haiqing Cai
- Department of Pediatric Orthopedics, Shanghai Children's Medical Center, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
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Sinha SK, Kumar V, Singh A. Outcomes of fracture shaft femur in pediatric population managed at emergency. J Clin Orthop Trauma 2017; 8:313-319. [PMID: 29062211 PMCID: PMC5647623 DOI: 10.1016/j.jcot.2016.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 11/18/2016] [Accepted: 12/08/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Fracture shaft of femur is amongst one of the commonest major diaphyseal injuries in school going children presenting to us at emergency rooms of our hospitals. The presence of a growing proximal and distal physes imposes a real challenge in management of these fractures. The use of titanium elastic nails has gained wide acceptance for stabilizing these fractures. MATERIALS AND METHODS A sample of 53 children of age group 6 to 12 years were included in the study according to the inclusion and exclusion criteria. The mean age of subjects was 8.87 ± 1.64 years of which 39 were males and 14 were females. The femoral shaft fractures were stabilized using titanium elastic nails and followed up for a mean duration of six months. The outcomes were evaluated based on Flynn's criteria. RESULTS We obtained excellent outcome in 75.5% of our cases, satisfactory outcome in 17% and poor outcome in 7.5% of cases. We found no statistically significant difference in outcome in patients of age 9 years or less compared to 10 years or older. CONCLUSION Patient selection is important to obtain good results using titanium elastic nails. Mid diaphyseal femoral shaft fractures with minimal comminution are ideal fractures for treatment using titanium elastic nails.
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Canavese F, Marengo L, Andreacchio A, Mansour M, Paonessa M, Rousset M, Samba A, Dimeglio A. Complications of elastic stable intramedullary nailing of femoral shaft fractures in children weighing fifty kilograms (one hundred and ten pounds) and more. INTERNATIONAL ORTHOPAEDICS 2016; 40:2627-2634. [PMID: 27506569 DOI: 10.1007/s00264-016-3259-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 07/25/2016] [Indexed: 10/21/2022]
Abstract
AIM The purpose of this study was to assess treatment outcomes in children weighing 50 kg (110 pounds) or more with displaced femur shaft fractures treated by elastic stable intramedullary nailing (ESIN) and to identify potential correlations between nail size/medullary canal diameter ratio and outcome. METHODS Twenty out of 117 consecutive children surgically treated by ESIN for displaced fractures of the femoral shaft with no associated neurovascular injury weighed 50 kg (110 pounds) or more. All patients underwent regular clinical and radiographic follow-up for at least one year after their index surgery. RESULTS The average patient age at the time of injury was 13.1 years (25th and 75th interquartile range [IQR] = 11.7-14.5). The mean follow-up was 27.4 months (IQR = 18.4-36.8). Overall, nine (45 %) adverse events were observed. The rate of complications was higher among children weighting 55 kg and over (67 %) than in children weighing less than 55 kg (35 %) and among children aged 13 years old or older (72 %) than among children younger than 13 years old (11 %). DISCUSSION Femoral shaft fractures in children and adolescents weighing 50 kg (110 pounds) and over and older than ten years of age have an increased rate of complications. CONCLUSION Heavier patients have a greater chance of complications. In particular, patients younger than 13 years old and weighing less than 55 kg can be safely managed with ESIN, but older and heavier patients should preferably be treated with rigid fixation systems due to a greater complication rate. However, further studies are needed to consolidate the conclusions.
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Affiliation(s)
- Federico Canavese
- Pediatric Surgery Department, University Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont Ferrand, France.
| | - Lorenza Marengo
- Pediatric Surgery Department, University Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont Ferrand, France
| | - Antonio Andreacchio
- Pediatric Orthopaedic Surgery Department, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126, Torino, Italy
| | - Mounira Mansour
- Pediatric Surgery Department, University Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont Ferrand, France
| | - Matteo Paonessa
- Pediatric Orthopaedic Surgery Department, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126, Torino, Italy
| | - Marie Rousset
- Pediatric Surgery Department, University Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont Ferrand, France
| | - Antoine Samba
- Pediatric Surgery Department, University Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont Ferrand, France
| | - Alain Dimeglio
- Faculty of Medicine, University of Montpellier, 2 Rue de l'École de Médecine, 34090, Montpellier, France
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Mohamed A, Rajeev AS. Clinical outcomes and complications of titanium versus stainless steel elastic nail in management of paediatric femoral fractures-a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:157-167. [PMID: 27838785 DOI: 10.1007/s00590-016-1880-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 11/02/2016] [Indexed: 01/19/2023]
Abstract
Femoral shaft fractures in children account for approximately 1.6% of all fractures. These fractures can be treated both operatively and non-operatively. Surgical fixation is more common in the age group above 6 years. Elastic intramedullary nails have become the most popular surgical modality of treatment over the last few decades. However, there is continuous debate about which type of elastic nails (titanium and stainless steel) provides better clinical outcomes with less complication. The main purpose of this study was to systematically search for and critically appraise articles comparing clinical outcomes and complications of titanium elastic nail system (TENS) and stainless steel elastic nail system (SSENS) in management of femoral fractures in the paediatric age group. A comprehensive search of MEDLINE, EMBASE, and Cochrane library databases was performed using specific search terms and limits. Applying strict eligibility criteria, the identified studies were screened. Five studies were identified and reviewed. All of the identified studies were non-randomised comparative studies apart from one randomised controlled study. Studies provide contradictory evidence with regard to time to fracture union and time to full weight bearing. Only one study commented on time to nail removal and found that it is shorter in the TENS group. Two studies showed significantly higher rate of malunion in the TENS group, whereas the rest showed no difference. There was no difference in the rates of delayed union or infection between the two groups and no consistent difference in the rates of skin irritation. Three studies compared Flynn's outcome score and found no difference apart from one study which found better scores in the SSENS group. There is no consistent evidence to indicate the advantage of one type of elastic nails over the other in management of paediatric femoral shaft fractures; however, the overall trend is in favour of SSENS especially being cheaper than TENS. Critical appraisal of the studies identified significant methodological deficiencies, and further prospective randomised trials are recommended for more potent evidence.
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Affiliation(s)
- Abdalla Mohamed
- Queen Elizabeth Hospital, Gateshead, Tyne and Wear, NE9 6SX, UK
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Gyaneshwar T, Nitesh R, Sagar T, Pranav K, Rustagi N. Treatment of pediatric femoral shaft fractures by stainless steel and titanium elastic nail system: A randomized comparative trial. Chin J Traumatol 2016; 19:213-6. [PMID: 27578377 PMCID: PMC4992107 DOI: 10.1016/j.cjtee.2016.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Literature suggests that the lower modulus of elasticity of titanium makes it ideal for use in children compared with stainless steel. Better fracture stability was observed in association with titanium nails on torsional and axial compression testing. However, stainless steel nails are stiffer than titanium counterparts, which may provide a rigid construct when fixing paediatric femoral shaft fractures. Complications have been observed more frequently by various researchers when titanium nails are used for fracture fixation in patients with increasing age or weight. The concept of this study was to compare the functional outcome after internal fixation with titanium elastic nail system and stainless steel elastic nail system in paediatric femoral shaft fractures. METHODS The study was conducted on 34 patients admitted in the department of orthopaedics, LLRM Medical College & SVBP Hospital, Meerut, India from January 2013 to August 2014. We included patients aged 5-12 years with fracture of the femoral shaft, excluding compound fractures, pathological fractures and other lower limb fractures. Patients were treated by titanium (n=17) or stainless steel (n=17) elastic nail system and followed up for one year. The clinical parameters like range of motion at hip and knee joints, time to full weight bearing on the operated limb and radiological parameters like time to union were compared between two groups. A special note was made of intra- and post-operative complications. Functional outcomes were analysed according to Flynn criteria. RESULTS Based on the Flynn criteria, 59% of patients had excellent results, 41% had satisfactory results, and no one showed poor results. There was no clinically significant difference between the two groups with respect to time to union and full weight bearing. But the incidence of puncture of the opposite cortex while inserting the nail and trying to advance it through the diaphysis during operation is greatly different. Only one such case was observed in titanium group but five in stainless steel group. CONCLUSION Majority of paediatric femoral shaft fractures are now treated operatively by elastic stable intramedullary nails. Operative intervention results in a shorter hospital stay and has economic and social benefits over conservative treatment. The cost of stainless steel nail is one third the cost of titanium nail. However, the clinico-radiological results are not significantly different between titanium and stainless steel nails at one year follow-up as observed by our study.
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The management of paediatric diaphyseal femoral fractures: a modern approach. Strategies Trauma Limb Reconstr 2016; 11:87-97. [PMID: 27401456 PMCID: PMC4960060 DOI: 10.1007/s11751-016-0258-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 06/20/2016] [Indexed: 02/08/2023] Open
Abstract
The definitive treatment of paediatric femoral diaphyseal fractures remains controversial. Modalities of treatment vary mostly according to age, with fracture pattern and site having a lesser impact. Current evidence is reflective of this variation with most evidence cited by the American Academy of Orthopedic Surgeons being level 4 or 5. The authors present a review of the most up-to-date evidence relating to the treatment of these fractures in each age group. In an attempt to clarify the current trends, we have produced an algorithm for decision-making based on the experience from our own tertiary referral level 1 major trauma centre.
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Galal S. External fixation of paediatric subtrochanteric fractures using calcar rather than neck pins. Strategies Trauma Limb Reconstr 2016; 11:99-104. [PMID: 27072558 PMCID: PMC4960054 DOI: 10.1007/s11751-016-0252-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 04/05/2016] [Indexed: 11/25/2022] Open
Abstract
Subtrochanteric femoral fractures in children are uncommon and have received limited attention in the literature. Its treatment is controversial, and different options are available: traction, spica casting, internal fixation and external fixation. The aim of this study is to present our results with external fixation of subtrochanteric femoral fractures in children using Ilizarov frame. Between January 2012 and January 2014, 14 patients with closed subtrochanteric femoral fractures were treated in Cairo University School of Medicine Teaching Hospital. The average age at the time of injury was 6.4 years (range 3.8–11.5 years). Pathological fractures and fractures associated with neuromuscular diseases were excluded from this study. Two patients were multiply injured with abdominal injuries (as ruptured spleen). In all cases, a low profile Ilizarov frame was inserted using two half pins inserted proximally from greater to lesser trochanters parallel to the hip joint orientation line (line between tip of greater trochanter and femoral head centre) and secured to an arch, and another three half pins were inserted distally perpendicular to the femoral shaft and secured to an arch that was connected by three rods to the proximal arch. No post-operative spica was used. Average follow-up was 18 months (range 12–36 months). All fractures united with anatomical alignment within an average of 8 weeks (range 6–12 weeks). There were no deep infections and no significant limb length discrepancies. At the latest follow-up, no patient had any restriction of activities. External fixation with a low profile Ilizarov frame appears as a good treatment option for subtrochanteric femoral fractures in children. Level of evidence: Level IV.
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Affiliation(s)
- Sherif Galal
- Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Kasr AL-Ainy School of Medicine, Cairo University, Cairo, 11559, Egypt.
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Kushare IV, Oetgen ME, Walters SJ. Spontaneous Hemarthrosis of the Knee - Late Complication of Flexible Femur Nailing: A Case Report. Trauma Mon 2016; 21:e23063. [PMID: 28180118 PMCID: PMC5282937 DOI: 10.5812/traumamon.23063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 12/15/2014] [Indexed: 11/16/2022] Open
Abstract
We present a case report of acute spontaneous knee hemarthosis due to erosion of the nail through the knee joint capsule in a boy, seven months following retrograde flexible nailing for fractured femur. Careful positioning of the location of the insertion site of flexible nails and proper nail tip management are important to avoid this rare late complication.
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Affiliation(s)
- Indranil V Kushare
- Division of Orthopedics, Nationwide Children’s Hospital, Columbus OH, USA
| | - Matthew E Oetgen
- Division of Orthopaedic Surgery and Sports Medicine, Children’s National Medical Center, Washington DC, USA
| | - Suzanne J Walters
- Division of Orthopaedic Surgery and Sports Medicine, Children’s National Medical Center, Washington DC, USA
- Corresponding author: Suzanne J Walters, Division of Orthopaedic Surgery and Sports Medicine, Children’s National Medical Center, Washington DC, USA. Tel: +1-2024764535, Fax: +1-2024764613, E-mail:
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Wani MM, Rashid M, Dar RA, Bashir A, Sultan A, Wani I, Rashid S, O'Sullivan M. Use of external fixator versus flexible intramedullary nailing in closed pediatric femur fractures: comparing results using data from two cohort studies. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:223-30. [PMID: 26754113 DOI: 10.1007/s00590-015-1737-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 12/21/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Although external fixation and flexible intramedullary nailing have been extensively used in the management of pediatric femur fractures, there are very few studies, which have compared the results. The purpose of the study was to compare the results of external fixation and flexible intramedullary nailing in pediatric femur fractures. METHODS Two groups of patients were treated by external fixator (EF) and flexible intramedullary nailing (FIN) over two different but successive time periods and results compared. The first group (EF) consisted of 45 patients, and the second group had 50 patients. RESULTS The age in EF group ranged from 6 to 14 years (average 9.93 years), and the age in FIN group ranged from 6 to 11 years (average 7.66 years). In the EF group, fixator was removed at an average of 12.23 weeks. In the FIN group, radiographic union was evident at an average time of 10.06 weeks. Pin-site infection was common in EF group. One patient had a re-fracture in EF group, and one patient had to be re-operated in FIN group after he developed anterior angulation of more than 30°. CONCLUSION We believe that it is the discretion of the surgeon to operate on the femur fracture using either of the treatment modalities. Further randomized studies need to be conducted between these two treatment modalities.
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Affiliation(s)
- Mubashir Maqbool Wani
- Department of Orthopaedics, Medical College Srinagar, Hospital for Bone and Joint Surgery, Barzulla, J&K, 190005, India.
| | - Mubashir Rashid
- Department of Orthopaedics, SKIMS Medical College, Srinagar, J&K, 190018, India
| | - Riyaz Ahmad Dar
- Department of Orthopaedics, Medical College Srinagar, Hospital for Bone and Joint Surgery, Barzulla, J&K, 190005, India
| | - Arshad Bashir
- Department of Orthopaedics, Medical College Srinagar, Hospital for Bone and Joint Surgery, Barzulla, J&K, 190005, India
| | - Asif Sultan
- Department of Orthopaedics, Medical College Srinagar, Hospital for Bone and Joint Surgery, Barzulla, J&K, 190005, India
| | - Iqbal Wani
- Department of Orthopaedics, Medical College Srinagar, Hospital for Bone and Joint Surgery, Barzulla, J&K, 190005, India
| | - Shakir Rashid
- Department of Orthopaedics, Medical College Srinagar, Hospital for Bone and Joint Surgery, Barzulla, J&K, 190005, India
| | - Mark O'Sullivan
- Department of Orthopaedics, Royal Children's Hospital, Melbourne, Australia
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Soni JF, Schelle G, Valenza W, Pavelec AC, Souza CDA. UNSTABLE FEMORAL FRACTURES TREATED WITH TITANIUM ELASTIC INTRAMEDULLARY NAILS, IN CHILDREN. Rev Bras Ortop 2015; 47:575-80. [PMID: 27047868 PMCID: PMC4799446 DOI: 10.1016/s2255-4971(15)30006-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 03/15/2012] [Indexed: 12/12/2022] Open
Abstract
Objective: To evaluate the indications, epidemiology, associated lesions, complications and prognosis among children with unstable femoral diaphysis fractures who were treated with titanium elastic intramedullary nails. Method: This was a retrospective analysis on 24 patients aged 5-12 years with unstable femoral diaphysis fractures who underwent surgical treatment with elastic titanium intramedullary nails at the Cajuru University Hospital, Curitiba-PR, between April 2002 and March 2008, with a minimum follow-up of 36 months. The epidemiological data, angular deviations, leg shortening and bone consolidation were evaluated. Results: The medical files of 113 cases operated between April 2002 and March 2008 were reassessed. From these, 24 cases of unstable femoral diaphysis fractures treated with elastic titanium intramedullary nails with retrograde insertion were included in the study. There were two bilateral fractures and two exposed fractures. Seven patients were female and 17 were male, and the mean age was 8.3 years. The following were presented at the end of the study: shortening, varus or valgus displacement, final retrocurvatum or antecurvatum of zero, and absence of delayed consolidation or pseudarthrosis. Conclusions: The elastic titanium intramedullary nails were easily placed and removed. We believe that using elastic titanium intramedullary nails is a good option for fixation of unstable femoral fractures in children.
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Affiliation(s)
- Jamil Faissal Soni
- Head of the Pediatric Orthopedics Group, Orthopedics and Traumatology Clinic, Cajuru University Hospital, Pontifical Catholic University of Paraná (PUC-PR), and Workers’ Hospital, Federal University of Paraná (UFPR), Curitiba, PR, Brazil
- Adjunct Professor of Orthopedics, PUC-PR, Curitiba, PR, Brazil
- MSc and PhD in Orthopedics, Curitiba, PR, Brazil
- Correspondence: Avenida Silva Jardim 1502, ap. 91, 80250-200 Curitiba, ParanáCorrespondence: Avenida Silva Jardim 1502ap. 91CuritibaParaná80250-200
| | - Gisele Schelle
- Attending Physician in the Pediatric Orthopedics Group, Orthopedics and Traumatology Clinic, Cajuru University Hospital, Pontifical Catholic University of Paraná (PUC-PR), and Workers’ Hospital, Federal University of Paraná (UFPR), Curitiba, PR, Brazil
| | - Weverley Valenza
- Attending Physician in the Pediatric Orthopedics Group, Orthopedics and Traumatology Clinic, Cajuru University Hospital, Pontifical Catholic University of Paraná (PUC-PR), and Workers’ Hospital, Federal University of Paraná (UFPR), Curitiba, PR, Brazil
| | - Anna Carolina Pavelec
- Attending Physician in the Pediatric Orthopedics Group, Orthopedics and Traumatology Clinic, Cajuru University Hospital, Pontifical Catholic University of Paraná (PUC-PR), and Workers’ Hospital, Federal University of Paraná (UFPR), Curitiba, PR, Brazil
| | - Camila Deneka Arantes Souza
- Third-year Resident Physician in the Orthopedics and Traumatology Clinic, Cajuru University Hospital, Pontifical Catholic University of Paraná (PUC-PR), Curitiba, PR, Brazil
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50
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Risk factors for complications and readmission after operative fixation of pediatric femur fractures. J Child Orthop 2015; 9:307-11. [PMID: 26238610 PMCID: PMC4549346 DOI: 10.1007/s11832-015-0672-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/20/2015] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Operative fixation of pediatric femur fractures with intramedullary implants has grown in popularity in recent decades. However, risk factors for short-term adverse events and readmission have not been well studied. METHODS Pediatric patients who underwent intramedullary nailing of a femur fracture between 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Risk factors for any adverse event (AAE) and readmission after intramedullary nailing were evaluated using univariate and multivariate analysis. RESULTS A total of 522 pediatric patients who underwent intramedullary nailing of the femur during the study period were identified. The mean age of this patient cohort was 10.2 ± 3.8 years. Review of the cases revealed that 18 (3.4 %) patients had AAE and that 20 (3.8 %) patients were readmitted, of whom 13 (2.5 %) underwent a reoperation. Independent risk factors for AAE were a cardiac comorbidity [odds ratio (OR) 12.7, 95 % confidence interval (CI) 1.5, 103.7], open fracture (OR 10.2, 95 % CI 1.4, 74.4), and prolonged operative time (OR 17.5, 95 % CI 6.1, 50.5). Independent risk factors for readmission were a central nervous system disorder (OR 4.5, 95 % CI 1.3, 16.2) and a seizure disorder (OR 4.9, 95 % CI 1.0, 23.5). CONCLUSIONS The results of the multivariate analysis suggest that cardiac comorbidities, open fractures, and prolonged operative time increase the risk for AAE and that central nervous system disorders and seizure disorders may increase the risk for readmission. Surgeons should be aware of these risk factors and counsel the families of pediatric patients who undergo intramedullary nailing of femur fractures.
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