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Wang SI, Jeong HJ, Lim ST, Han YH. Prediction of leg-length discrepancy in pediatric femoral shaft fracture using bone SPECT/CT: A case report. Medicine (Baltimore) 2023; 102:e35860. [PMID: 37933061 PMCID: PMC10627618 DOI: 10.1097/md.0000000000035860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023] Open
Abstract
RATIONALE Children's bones are in the process of growing in both length and width. Therefore, evaluating whether fractures affect the growth plate or not is very crucial. However, even in cases of lower limb fractures where the growth plate remains unaffected, overgrowth or shortening of the affected limb are encountered. PATIENT CONCERNS An 11-year-old boy was admitted to the emergency department after a passenger car accident. DIAGNOSES A comminuted fracture of the right femoral shaft was diagnosed by X-ray image. INTERVENTIONS Closed reduction and internal fixation were performed using intramedullary titanium elastic nails. Six months after the operation, bone union was achieved and the nails were removed. OUTCOMES Nine months after nail removal, the right leg was unexpectedly noticed 5 mm shorter than the left one. On the initial and follow-up bone single-photon emission computed tomography/computed tomography images with a 9-month interval, radioactivity of growth plate in the right proximal femur was much lower than that of the left femur, suggesting a further increasing of leg-length discrepancy (LLD) in the future. As we expected, LLD had progressively increased up to 20 mm. Epiphysiodesis was finally decided for the left distal femur. Twenty-two months after the length equalization operation, LLD decreased to 5 mm. LESSONS This case emphasizes that quantitative analysis of growth plate activity using bone single-photon emission computed tomography/computed tomography could predict LLD and help us decide when and which limb should be operated on for pediatric patients with lower limb fractures.
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Affiliation(s)
- Sung Il Wang
- Department of Orthopaedics Surgery, Jeonbuk National University Medical School, Research Institute for Endocrine Sciences and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeonbuk, South Korea
| | - Hwan-Jeong Jeong
- Department of Nuclear Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jounbuk National University Medical School and Hospital, Jeonju, Jeonbuk, South Korea
| | - Seok Tae Lim
- Department of Nuclear Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jounbuk National University Medical School and Hospital, Jeonju, Jeonbuk, South Korea
| | - Yeon-Hee Han
- Department of Nuclear Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jounbuk National University Medical School and Hospital, Jeonju, Jeonbuk, South Korea
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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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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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Lu D, Yang J, Zhang JD, Chen H, Sun LJ. The outcomes of pediatric femoral shaft fractures treated surgically by different types of orthopedists. Injury 2017; 48:548-551. [PMID: 27923475 DOI: 10.1016/j.injury.2016.11.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/24/2016] [Accepted: 11/28/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The objective of this study was to compare the outcomes of pediatric femoral shaft fractures treated with titanium elastic nail (TEN) by pediatric orthopedists and non-pediatric orthopedists. METHODS From May 2006 to June 2014, 88 children with femoral shaft fractures were randomized to operative stabilization either by pediatric orthopedists (Group A, 44 cases) or by non-pediatric orthopedists (Group B, 44 cases). Demographic data and clinical characteristics (age, sex, weight, fracture side and type, cause of injury, associated injuries and interval from injury to surgery) were comparable between the two groups before surgery. Peri-operative data, clinical and functional outcomes between the two groups were recorded. RESULTS The mean follow-up period was 20.9±4.5months for Group A and 20.0±3.6months for Group B (P=0.356). There was no significant difference in the time to union, length of hospitalization, full weight-bearing time and TEN scores between the two groups (P=0.785, P=0.835, P=0.803, P=0.940, respectively). However, the mean operating time and radiation time was longer in Group B than in Group A (P=0.001 and P=0.047, respectively). Also, there was a trend for patients of Group B to have a higher rate of open reduction (P=0.047). When comparing the total complications, no significant difference existed between the groups (P=0.978). CONCLUSIONS This study indicated that both pediatric and non-pediatric orthopedists provided satisfactory clinical and functional results in treating these common injuries.
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Affiliation(s)
- Di Lu
- Department of Orthopaedic Surgery, Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, China
| | - Jie Yang
- Department of Orthopaedic Surgery, Wenzhou People's Hospital, Wenzhou, Zhejiang, China
| | - Jing-Dong Zhang
- Department of Orthopaedic Surgery, Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, China
| | - Hua Chen
- Department of Orthopaedic Surgery, Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, China
| | - Liao-Jun Sun
- Department of Orthopaedic Surgery, Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, 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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Guo YC, Feng GM, Xing GW, Yin JN, Xia B, Dong YZ, Niu XQ, He Q, Hu P. A meta-analysis of flexible intramedullary nailing versus external fixation for pediatric femoral shaft fractures. J Pediatr Orthop B 2016; 25:466-70. [PMID: 27294706 DOI: 10.1097/bpb.0000000000000336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To compare the difference in efficacy following flexible intramedullary nailing (FIN) and external fixation (EF) for pediatric femoral shaft fractures. A systematic search was performed on PubMed, Embase, Medline, and Cochrane library for relevant studies. We included controlled trials comparing complications between FIN and EF for pediatric femoral shaft fractures published before 25 November 2014. Modified Jadad scores were utilized to assess the methodological quality of the studies included. The meta-analysis was carried out using Stata 12.0 software. Six studies involving 237 patients were included. On comparison of EF, a low incidence of overall complications [relative risk (RR)=0.30, 95% confidence interval (CI): 0.19-0.46; P<0.001] and pin-tract infection (RR=0.286, 95% CI: 0.13-0.61; P=0.001), but a high risk of soft tissue irritation (RR=1.86, 95% CI: 1.35-2.56; P<0.001) were found in patients treated with the FIN approach. No significant differences in other complications were found. On the basis of current evidence, the use of FIN leads to fewer complications than EF and may be considered as the first-line approach in the treatment of femoral shaft fractures.
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Affiliation(s)
- Yong Cheng Guo
- aDepartment of Orthopedics, the Third Affiliated Hospital of Zhengzhou University bDepartment of Internal Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou,China
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Lardelli P, Frech-Dörfler M, Holland-Cunz S, Mayr J. Slow Recovery of Weight Bearing After Stabilization of Long-Bone Fractures Using Elastic Stable Intramedullary Nails in Children. Medicine (Baltimore) 2016; 95:e2966. [PMID: 26986106 PMCID: PMC4839887 DOI: 10.1097/md.0000000000002966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Stabilization of diaphyseal long-bone fractures using elastic stable intramedullary nails (ESIN) in children promises early mobilization and rapid resumption of full weight bearing. We evaluated the duration of postoperative functional rehabilitation after ESIN, measured by the time from stabilization until first partial weight bearing, full weight bearing, and resumption of school sports. Fifty children with unstable, displaced fractures of the femur or lower leg treated with ESIN between 2002 and 2012 were included in this retrospective analysis. We classified fractures according to the pediatric comprehensive classification of fractures (PCCF). Thirty-five children sustained a femur fracture, and 15 children had a fracture of the lower leg or tibia. The surgeons in charge applied an additional plaster cast in 7 of 15 children who suffered a lower leg fracture. The postoperative time interval until full weight bearing in the group of children who had suffered transverse or short oblique femur fractures was significantly shorter (median: 4.4 weeks; range: 0.1-9.1 weeks) than that in the group who had sustained more complex fracture patterns (median: 6.8 weeks; range: 2.9-13.9 weeks; P = 0.04). Similarly, transverse and short oblique lower leg and tibia fractures required less time until full weight bearing (median: 4.1 weeks; range 2.7-6.0 weeks) than complex lower leg fractures (median: 6.1 weeks; range: 1.3-12.9 weeks; P = 0.04). ESIN proved fairly effective in restoring full weight bearing in transverse or short oblique fractures of the lower extremities but was less effective in complex fractures.
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Affiliation(s)
- Patrizia Lardelli
- From the Department of Paediatric Surgery, University Children's Hospital Basel (Switzerland), Basel, Switzerland
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Surgical treatment of femoral diaphyseal fractures in children using elastic stable intramedullary nailing by open reduction at Yopougon Teaching Hospital. Orthop Traumatol Surg Res 2015. [PMID: 26215090 DOI: 10.1016/j.otsr.2015.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Elastic stable intramedullary nailing (ESIN) has transformed children's femoral shaft fracture treatment, but this technique requires an image intensifier. Without it, open reduction is used to check fracture reduction and pin passage. The aim of this study was to describe our techniques and to evaluate our results at the middle term. HYPOTHESIS The open reduction and ESIN technique provides satisfactory results with few major complications. PATIENTS AND METHODS This was a retrospective study that focused on femoral diaphyseal fractures treated in the pediatric surgery unit at Yopougon Teaching Hospital (Abidjan, Côte d'Ivoire) between January 2007 and December 2013. Twenty children older than 6 years of age who underwent open reduction and ESIN without image intensifier assistance were included. Functional outcomes were assessed using Flynn's criteria. Postoperative complications and sequelae were recorded. RESULTS At the 16-month follow-up, the results were excellent in 11 (55%) cases, good in eight (40%), and poor in one (5%) case. The mean duration of surgery was 71min (range, 57-103 min). The mean time for bone healing was 11.6 weeks (range, 7-15 weeks) and the average time to nail removal was 6 months. Complications included wood infection (n=3), skin irritation (n=3), knee stiffness (n=2), malunion (n=3), scar (n=5), and leg length discrepancy (n=3). DISCUSSION Open reduction and ESIN yielded satisfactory results with few major complications. This method could be an alternative in low-income countries where the image intensifier is often unavailable. LEVEL OF EVIDENCE Level IV retrospective study.
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Sanzarello I, Calamoneri E, D'Andrea L, Rosa MA. Algorithm for the management of femoral shaft fractures in children. Musculoskelet Surg 2014; 98:53-60. [PMID: 23979725 DOI: 10.1007/s12306-013-0299-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 08/08/2013] [Indexed: 06/02/2023]
Abstract
PURPOSE Pediatric closed femoral shaft fractures are commonly related to a good prognosis. There is no consensus on treatment. We aimed to evaluate the treatment, features, radiological findings and management strategies, creating an algorithm of treatment. MATERIALS AND METHODS Fifty-two simple femoral shaft fractures in children were retrospectively evaluated for age and gender distribution, side of the fracture, etiology of injuries, limb length discrepancy, range of knee and hip motion and parents satisfaction with a mean clinical and radiographic follow-up of 3 years and 6 months. Twenty-eight patients were treated with reduction and early hip spica cast while 24 patients were treated with external fixation (EF). RESULTS Nearly 58 % of the cases were caused by traffic accidents and were predominantly male (61.5 %). Most of the fractures were of the middle femoral shaft (57.6 %). Muscle strength was normal (MRC scale) in all patients with no pain (NIPS and PRS scale). Knee and Hip range of motion were similar in both types of treatment. Patients treated with EF had shorter limb length discrepancy compared with SC. There were no reports of re-fracture. We found a higher familiar satisfaction in patients treated with EF. CONCLUSIONS An algorithm for the management of femoral shaft fractures in the pediatric population is proposed. Results on the study population gave raise to a satisfactory clinical and radiological results.
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Affiliation(s)
- I Sanzarello
- Section of Orthopaedics, University of Messina, Messina, Italy
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Ruhullah M, Singh HR, Shah S, Shrestha D. Primary hip spica with crossed retrograde intramedullary rush pins for the management of diaphyseal femur fractures in children: A prospective, randomized study. Niger Med J 2014; 55:111-5. [PMID: 24791042 PMCID: PMC4003711 DOI: 10.4103/0300-1652.129638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Femoral fractures are common in children aged between 2 and 12 yearsand 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as a conservative treatment. We compared primary hip spica or traction followed by hip spica with closed reduction and fixation with retrogradely passed crossed Rush pins for diaphyseal femur fracture in 25 children of the age group 3-12 years, randomly distributed in each group. Materials and Methods: Fifty children (age: 3-13 years, mean; 9 years) with femoral fractures were evaluated; 25 of them underwent the conservative treatment using immediate hip spica (group A) and 25 underwent treatment with crossed retrograde Rush pins (group B). Results: Mean duration of fracture union was within 15 weeks in group A and 12 weeks in group B. Mean duration of weight bearing was 14weeks in group A and 7 weeks in group A. Mean hospital stay were 4 days in group A and 8days in group B. The man follow-up period was 16 months in group A and 17 months in group B. Complications like angulation, shortening and infection were compared. Bursitis and penetration of pins at the site of Rush pin insertion is a complication associated with this method of treatment. Conclusion: Closed reduction and internal fixation with crossed Rush pins was a superior treatment method in terms of early weight bearing and restoration of normal anatomy.
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Affiliation(s)
- Mohammad Ruhullah
- Department of Orthopaedics, National Medical College, Birganj, Nepal
| | - H R Singh
- Department of Orthopaedics, National Medical College, Birganj, Nepal
| | - Sanjay Shah
- Department of Orthopaedics, National Medical College, Birganj, Nepal
| | - Dipak Shrestha
- Department of Orthopaedics, Dhulikhel Hospital, Dhulikhel, Nepal
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Ruhullah M, Singh HR, Shah S, Shrestha D. Hip spica versus Rush pins for management of femoral diaphyseal fractures in children. Indian J Orthop 2014; 48:488-94. [PMID: 25298556 PMCID: PMC4175863 DOI: 10.4103/0019-5413.139860] [Citation(s) in RCA: 3] [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: 02/04/2023]
Abstract
BACKGROUND Femoral fractures are common in children between 2 and 12 years of age and 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as conservative treatment. We compared primary hip spica with closed reduction and fixation with retrogradely passed crossed Rush pins for diaphyseal femur fracture in children. The hypothesis was that Rush pin might provide better treatment with good clinical results in comparison with primary hip spica. MATERIALS AND METHODS Fifty children with femoral fractures were evaluated; 25 of them underwent conservative treatment using immediate hip spica (group A) and 25 were treated with crossed retrograde Rush pins (group B). The patients ages ranged from 3 to 13 years (mean of 9 years). RESULTS Mean duration of fracture union was 15 weeks in group A and 12 weeks in group B. Mean duration of weight bearing 14 weeks in group and 7 weeks in group B. Mean hospital stay was 4 days in group A and 8 days in group B. Mean followup period in group A was 16 months and group B was 17 months. Complications such as angulation, shortening, infection were compared. CONCLUSIONS Closed reduction and internal fixation with crossed Rush pins was superior in terms of early weight bearing and restoration of normal anatomy.
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Affiliation(s)
- Mohammad Ruhullah
- Department of Orthopaedics, National Medical College Teaching Hospital, Birganj, Nepal,Address for correspondence: Dr. Mohammad Ruhullah, Department of Orthopaedics, National Medical College Teaching Hospital, Birgunj, Nepal. E-mail:
| | - Hare Ram Singh
- Department of Orthopaedics, National Medical College, Birganj, Nepal
| | - Sanjay Shah
- Department of Orthopaedics, National Medical College, Birganj, Nepal
| | - Dipak Shrestha
- Department of Orthopaedics, Dhulikhel Hospital, Dhulikhel, Nepal
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12
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Ruhullah M, Shah S, Singh HR, Shrestha D. Comparison of Primary Hip Spica with Crossed Retrograde Intramedullary Rush Pins for the Management of Diaphyseal Femur Fractures in Children: A Prospective, Randomized Study. Open Access Maced J Med Sci 2013. [DOI: 10.3889/oamjms.2013.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Femoral fractures are common in children between 2 and 12 years of age, and 75% of the lesions affect the femoral shaft. We compared primary hip spica with closed reduction and fixation with retrogradely crossed Rush pins for diaphyseal femur fracture in 25 children of age group 3 to 13 years randomly distributed in each group.Methods: Fifty children with femoral fractures were evaluated; 25 of them underwent conservative treatment using immediate hip spica (group A) and 25 were treated with crossed retrograde Rush pins (group B). The patients ages ranged from 3 to 13 years (mean age 5.6±3.57 yrs).Results: Mean clinico-radiological consolidation was within 15 weeks in group A and 12 weeks in group B. Mean duration of weight bearing 7 weeks in group B and 14 weeks in group A. Mean hospital stay were 8 days in group B and 4 days in group A. Mean follow up period in group A was 16 months and group B was 17 months. Complications like angulation, shortening, infection were compared. Bursitis and penetration of pins at the site of Rush pin insertion is complication associated with this method of treatment. Conclusions: Intra-medullary crossed Rush pinning is an effective method of paediatric diaphyseal femur fracture fixation as compared to primary hip spica in terms of early weight bearing and restoration of normal anatomy.
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Is there a role for Ender's nailing of paediatric femoral fractures in a resource-restricted hospital set-up? J Pediatr Orthop B 2013; 22:101-5. [PMID: 23277291 DOI: 10.1097/bpb.0b013e32835c2a33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Paediatric femur fractures are managed with the titanium elastic nail system (TENS) in the 5-16-year age group. TENS is costly and not easily available in public hospitals. This study compares TENS nailing with stainless-steel Ender's nail fixation of paediatric femur fractures. A retrospective analysis of patient records from 2006 to 2008 yielded 31 children, 5-16 years of age, who underwent flexible nailing for isolated femur fractures. Sixteen children underwent Ender's nailing and 15 underwent TENS nailing. A significant difference in the coronal plane deformity was found in the TENS nailing group compared with Ender's nailing. The union time and time to weight bearing were significantly shorter for Ender's nailing than TENS nailing. The outcome according to Flynn's criteria was significantly better in the Ender's nailing group. The results of Ender's nailing in paediatric femur fractures were comparable with TENS, with a rapid healing time and reduced angular malunion.
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Palmu SA, Lohman M, Paukku RT, Peltonen JI, Nietosvaara Y. Childhood femoral fracture can lead to premature knee-joint arthritis. 21-year follow-up results: a retrospective study. Acta Orthop 2013; 84:71-5. [PMID: 23343379 PMCID: PMC3584607 DOI: 10.3109/17453674.2013.765621] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE During the past decades, treatment of pediatric femoral fractures in Finland has changed from mostly non-operative to more operative. In this retrospective study, we analyzed the long-term results of treatment. PATIENTS AND METHODS 74 patients (mean age 7 (0-14) years) with a femoral fracture were treated in Aurora City Hospital in Helsinki during the period 1980-89. 52 of 74 patients participated in this clinical study with a mean follow-up of 21 (16-28) years. Fracture location, treatment mode, time of hospitalization, and fracture alignment at union were assessed. Subjective assessment and range of motion of the hip and knee were evaluated. Leg-length discrepancy and alignment of the lower extremities were measured both clinically and radiographically. RESULTS Of the 52 children, 28 had sustained a shaft fracture, 13 a proximal fracture, and 11 a distal fracture. 44 children were treated with traction, 5 by internal fixation, and 3 with cast-immobilization. Length of the hospital treatment averaged 58 (3-156) days and the median traction time was 39 (3-77) days. 21 of the 52 patients had angular malalignment of more than 10 degrees at union. 20 patients experienced back pain. Limping was seen in 10 patients and leg-length discrepancy of more than 15 mm was in 8 of the 52 patients. There was a positive correlation between angular deformity and knee-joint arthritis in radiographs at follow-up in 6 of 15 patients who were over 10 years of age at the time of injury. INTERPRETATION Angular malalignment after treatment of femoral fracture may lead to premature knee-joint arthritis. Tibial traction is not an acceptable treatment method for femoral fractures in children over 10 years of age.
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Affiliation(s)
- Sauli A Palmu
- Children’s Hospital, Helsinki University Central Hospital, Helsinki,Orton Orthopaedic Hospital, Orton Foundation, Helsinki,Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere
| | | | - Reijo T Paukku
- Children’s Hospital, Helsinki University Central Hospital, Helsinki,Orto-Lääkärit, Medical Center, Helsinki, Finland
| | - Jari I Peltonen
- Children’s Hospital, Helsinki University Central Hospital, Helsinki,Orton Orthopaedic Hospital, Orton Foundation, Helsinki
| | - Yrjänä Nietosvaara
- Children’s Hospital, Helsinki University Central Hospital, Helsinki,Orto-Lääkärit, Medical Center, Helsinki, Finland
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15
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Nascimento FPD, Santili C, Akkari M, Waisberg G, Braga SDR, Fucs PMMDB. Flexible intramedullary nails with traction versus plaster cast for treating femoral shaft fractures in children: comparative retrospective study. SAO PAULO MED J 2013; 131:5-12. [PMID: 23538589 PMCID: PMC10852077 DOI: 10.1590/s1516-31802013000100002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 10/17/2011] [Accepted: 06/12/2012] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Femoral fractures are common in children between 2 and 12 years of age, and 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as conservative treatment. However, in some situations, a surgical approach is recommended. The objective here was to compare treatments for femoral shaft fractures using intramedullary nails (titanium elastic nails, TEN) versus traction and plaster casts in children. The hypothesis was that TEN might provide better treatment, with good clinical results in comparison with plaster casts. DESIGN AND SETTING This retrospective comparative study was conducted in a public university hospital. METHODS Sixty children with femoral fractures were evaluated; 30 of them underwent surgical treatment with TEN and 30 were treated conservatively using plaster casts. The patients' ages ranged from 5 to 13 years (mean of 9 years). RESULTS The mean duration of hospitalization was nine days for the surgical group and 20 days for the conservative group. The incidence of overgrowth in the patients treated with TEN was 60.0% and, for those treated conservatively, 13.3%. Partial weight-bearing was allowed after 3.5 weeks in the surgical group and after 9.6 weeks in the conservative group. New hospitalization was required for 90.0% in the surgical group and 16.7% in the conservative group. Patients treated with plaster casts presented higher incidence of complications, such as loss of reduction. CONCLUSIONS The surgical method presented better results for children.
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