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Qiao F, Shang X, Jiang F. Closed reduction and intramedullary nails for acute completely displaced femoral diaphysis fracture in children aged 2-6. Front Pediatr 2024; 12:1346456. [PMID: 38665374 PMCID: PMC11043553 DOI: 10.3389/fped.2024.1346456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Background The management of femoral fractures in children aged two to six years is still controversial. The purpose of this study was to assess the results of closed reduction and elastic stable intramedullary nail (ESIN) fixation in completely displaced fractures of the femoral diaphysis in children in this age group. Methods A retrospective review of all children with acute completely displaced fractures of the femoral diaphysis in children aged 2-6 years treated from 2013 to 2020 was performed. A total of 34 patients were treated who met the inclusion criteria: Group 1: 21 fractures (transverse and short oblique); Group 2: 13 fractures (long oblique and spiral) that underwent closed reduction and elastic stable intramedullary nail (ESIN) fixation. No differences existed between the 2 groups with respect to age, extremity, sex, time to treatment, mechanism of injury, or fracture displacement. Demographic characteristics and radiographs were reviewed, and the following parameters were documented: surgery time, time to union, return to activities, range of motion of knee joints, and complications. Major complications were defined as those with presumptive long-term side effects or those requiring a reoperation. No major complications were observed in the two groups. All included fractures were treated by a single senior paediatric surgeon. The mean follow-up period was 28.4 months (range 24-45 months). The level of significance was set at p < 0.05. Results Thirty-four children with acute completely displaced fractures of the femoral diaphysis were included: Group 1: 21 fractures; Group 2: 13 fractures. The patients included 15 girls (44.1%) and 19 boys (55.9%), with an average age of 4.4 years (range 2.8 to 6.5 years). The mean follow-up period was 28.4 months (range 24.2-45.0 months). The demographic characteristics did not differ between the two groups of patients. Overall, successful closed reduction and elastic stable intramedullary nail (ESIN) fixation could be achieved in all 34 patients. The mean surgical time was 40.4 and 43.0 min in Group 1 and Group 2, respectively (p = 0.857). Fluoroscopy time was not significantly different between the two groups (37.0 vs. 36.1 s, respectively; p = 0.247). Cosmetic results were described as good and satisfactory by all patients. There were no refractures and no incidences of nonunion or growth arrest in the proximal epiphysis. Only two patients suffered from a superficial infection, which was resolved after the pins were shortened and oral antibiotics were administered. Conclusion Closed reduction and elastic stable intramedullary nail (ESIN) fixation can be successfully used to treat completely displaced fractures of the femoral diaphysis in children aged two to six years. This technique is efficient and minimally invasive, and the results are satisfactory.
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Affiliation(s)
- Fei Qiao
- Department of Pediatric Orthopaedic, Dalian Women and Children’s Medical Group, Dalian, Liaoning, China
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Garg V, Gowda AKS, Regmi A, Barik S, Maheshwari VK, Singh V. Management of Length Unstable Femur Fractures in Children by Flexible Intramedullary Nails: A Systematic Review. ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE CECHOSLOVACA 2024; 91:44-51. [PMID: 38447564 DOI: 10.55095/achot2024/006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
PURPOSE OF THE STUDY Surgical options for paediatric femoral fractures include fl exible intramedullary nailing (FIN), plating, and external fi xators. Length unstable fractures are usually spiral, long oblique, or comminuted and are often associated with > 2 cm of shortening. The purpose of this study was to see whether FIN is effective for managing unstable femur fractures in children. MATERIAL AND METHODS An electronic literature search was performed up to 25 February 2022 in Cochrane Library, PubMed, and Embase databases using a combination of MeSH search terms and keywords related to the population (e.g., "child" AND "diaphyses" AND "femur"), and intervention (e.g., "nail" OR "ESIN"). The data extracted included the study details, Demographic data, surgical details, postoperative immobilization, complications, and outcome. RESULTS Eight studies with a total sample size of 369 patients were reviewed. The mean operative time, blood loss, and length of stay in the hospital were 67.62±12.32 minutes, 33.82±16.82 ml, and 4.9±1.27 days, respectively. The results were excellent in 61.92% of the patients, satisfactory in 32.61%, and poor in 5.43%. 4.54% of patients had major complications requiring reoperation and 32.46% of patients had minor complications. the most common complication was nail prominence seen in 26.30% of patients. Locked Ender's nail was associated with the least reoperation, malunion, and LLD rate compared to other types of FIN. CONCLUSIONS FIN along with a single walking spica cast is a good choice in all forms of paediatric femoral fracture patterns allowing proper alignment and rotation. Locked Ender's nail is safe and effective for managing unstable paediatric femur fracture. KEY WORDS pediatric femur fracture, length unstable, fl exible intramedullary nailing, submuscular plating, Flynn criterion.
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Affiliation(s)
- V Garg
- Department of Orthopedics, Chacha Nehru Bal chikitsalaya, Geeta colony, Delhi, India
| | - A K S Gowda
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - A Regmi
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - S Barik
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - V K Maheshwari
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - V Singh
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Mourkus H, Hussain S, Khalefa MA, Vadivelu R, Prem H. Preventing pressure ulcers from paediatric femoral traction: use of an audit cycle to assess a new concise manual and a daily care chart. Ann R Coll Surg Engl 2023; 105:173-177. [PMID: 35174721 PMCID: PMC9889178 DOI: 10.1308/rcsann.2021.0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Femoral shaft fractures are common in children up to 14 years of age and traction is frequently used during their treatment. A lack of training and unfamiliarity of junior doctors and nursing staff with this treatment modality may lead to unfavourable skin complications, especially in the absence of regular monitoring. We introduced and audited a simple and reproducible way of monitoring these patients. METHODS An initial audit was conducted of all children with femoral shaft fracture treated in skin traction. A new traction manual and daily care chart were introduced, and a re-audit was performed. A parallel survey regarding skin traction in children was conducted involving 33 hospitals in the United Kingdom. RESULTS The initial audit showed three patients (23%) developed grade 2 pressure sores with a mean duration of traction of 8.5 days. A pressure sites check was documented in only 7.7%. A re-audit, after introduction of the traction manual and daily care chart showed a mean duration of traction of 8.4 days and only one patient (12.5%) developed a grade 1 sore. Pressure site monitoring improved significantly with 75% documentation. No daily care chart was used among the 33 centres in the survey and only 27% of centres had access to a manual in the ward. CONCLUSIONS Introduction of a single-page traction manual and a daily care chart into patient care notes to effectively monitor for pressure areas in children on skin traction helps reduce the incidence of serious skin complications.
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Affiliation(s)
- H Mourkus
- Birmingham Women’s and Children’s NHS Foundation Trust, UK
| | - S Hussain
- Birmingham Women’s and Children’s NHS Foundation Trust, UK
| | - MA Khalefa
- Birmingham Women’s and Children’s NHS Foundation Trust, UK
| | - R Vadivelu
- Birmingham Women’s and Children’s NHS Foundation Trust, UK
| | - H Prem
- Birmingham Women’s and Children’s NHS Foundation Trust, UK
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Turgut A, Kumbaraci M, Yalçın E, Gezer MC, Bozkurt S, Kalenderer Ö. Analysis of the factors that are important in re-displacement in pediatric diaphyseal femur fractures treated with a spica cast. Injury 2022; 53:1013-1019. [PMID: 34627628 DOI: 10.1016/j.injury.2021.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/19/2021] [Accepted: 09/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is no detailed data on the factors affecting the re-displacement in pediatric femoral fractures treated with closed reduction and early spica casting. This study aimed to investigate the factors effective in re-displacement in pediatric diaphyseal femur fractures (PDFF) treated with spica casting. METHODS In all, 151 displaced PDFF were evaluated retrospectively. Demographic data of the patients were evaluated. Type of fractures, anteroposterior and lateral angulations, amount of shortening, translation ratio, cast index (CI), gap index (GI), and three-point index (TPI) measurements were evaluated radiologically. Thigh flexion angle (TFA) and knee flexion angle (KFA) were measured. After casting, angulation of more than 10° in any plane and a shortening of more than 10 mm was accepted as re-displacement. Binary logistic regression analysis was used to evaluate the risk factors of re-displacement. Receiver operating characteristic analysis was performed for TFA and KFA. RESULTS Re-displacement was detected in 40 patients (26.5%). Transverse type fracture (p = 0.001), TFA ˂71.4° (p <0.001), and KFA ˂52.6° (p = 0.002) were found to be statistically significant factors on re-displacement. It was determined that the combination of transverse femoral fracture and TFA ˂71.4° increased the probability of re-displacement by approximately 14 times. It has been observed that indices such as CI, GI, and TPI were not effective in predicting the risk of re-displacement. CONCLUSION When treating a PDFF with spica casting, one should be aware of re-displacement if the fracture type is transverse, TFA is ˂71.4°, and KFA is ˂52.6°. LEVEL OF EVIDENCE Level III, prognostic.
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Affiliation(s)
- Ali Turgut
- Tepecik Training and Research Hospital, Department of Orthopaedics and Traumatology, İzmir, Turkey.
| | - Mert Kumbaraci
- Tepecik Training and Research Hospital, Department of Orthopaedics and Traumatology, İzmir, Turkey
| | - Eren Yalçın
- Tepecik Training and Research Hospital, Department of Orthopaedics and Traumatology, İzmir, Turkey
| | - Mehmet Can Gezer
- Tepecik Training and Research Hospital, Department of Orthopaedics and Traumatology, İzmir, Turkey
| | - Safa Bozkurt
- Tepecik Training and Research Hospital, Department of Orthopaedics and Traumatology, İzmir, Turkey
| | - Önder Kalenderer
- Tepecik Training and Research Hospital, Department of Orthopaedics and Traumatology, İzmir, Turkey
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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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Antabak A, Boršćak N, Čagalj M, Ivelj R, Bumči I, Papeš D, Ćavar S, Bogović M, Bulić K, Luetić T. TREATMENT OF PEDIATRIC FEMORAL FRACTURES IN THE CITY OF ZAGREB. Acta Clin Croat 2020; 59:686-695. [PMID: 34285439 PMCID: PMC8253082 DOI: 10.20471/acc.2020.59.04.15] [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: 12/19/2016] [Accepted: 10/29/2018] [Indexed: 11/24/2022] Open
Abstract
Femur fractures in children can be treated with a number of operative and conservative methods. Numerous factors determine which method is optimal for a specific fracture. The aim of this research was to analyze distribution of femur fractures in children living in the urban communities of Zagreb and Zagreb County by localization, type and frequency of treatment methods used according to age and fracture mechanism. The research included 103 children aged up to 18 years, treated for femur fractures at the Zagreb University Hospital Centre and Zagreb Children’s Hospital. Data were collected from these institutions and a retrospective study covered the 2010-2015 period. The cause of fracture and diagnosis were coded with the help of the International Statistical Classification of Diseases and Related Health Problems. Operative treatment was applied in 55% of cases, which is contrary to previous researches. The highest incidence of femur fractures was recorded in the 0- to 4-year age groups, accounting for 49.1% of all fractures. These fractures mostly occurred due to falls and were more often treated with non-operative methods. All other age groups were mostly treated with operative methods. Coxofemoral immobilization and traction were used as non-operative methods, whereas flexible intramedullary nailing was the most frequently used operative method. The treatment depended on age, complexity of the fracture, fracture type, fragment displacement, and associated injuries. The cause was also an important factor on choosing the treatment method. Non-operative treatment was mostly used for fractures caused by falls (64.71% of cases due to falls) and operative treatment was mostly used for fractures caused by traffic accidents (79.4% of cases due to traffic accidents). It is a wide-known opinion that the best treatment for femur fractures in children is non-operative treatment. However, recent studies have shown that the use of operative methods in femur fracture treatment is growing. Our cohort of children treated during a five-year period (2010-2015) also underwent operative treatment more often than non-operative one. Two non-operative and eight operative methods were used. With such a large number of methods, it is clear that there is no unique method for all fractures. However, it is clear that the trend of using operative treatment is connected to the perennial trend of considerable sociodemographic and socioeconomic changes in urban settings such as Zagreb. Lifestyle changes directly affect the prevalence of femur fractures among children, as well as approach to treatment choice. General opinion is that most of fractures that occur at an early age can be treated with non-operative methods. Our research on femur fractures in children confirmed this rule. The youngest age group that had the highest incidence of fractures (49.1% of all fractures) was treated with non-operative methods in 75% of cases. Operative methods prevailed in other age groups. Similar results have been published by other authors. In conclusion, nearly half of all femur fractures (49.1%) occurred at a young age (0-4 years). Diaphysis fractures were most common. Most of the fractures that occurred during the 2010-2015 period were treated with operative methods, mostly in children aged 5-9 years. Out of eight different operative methods, elastic stable intramedullary osteosynthesis was most frequently used (60%). Coxofemoral immobilization and traction were used as non-operative methods.
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Affiliation(s)
| | - Nikolina Boršćak
- 1Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Zagreb Children's Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
| | - Marija Čagalj
- 1Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Zagreb Children's Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
| | - Renato Ivelj
- 1Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Zagreb Children's Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
| | - Igor Bumči
- 1Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Zagreb Children's Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
| | - Dino Papeš
- 1Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Zagreb Children's Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
| | - Stanko Ćavar
- 1Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Zagreb Children's Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
| | - Marko Bogović
- 1Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Zagreb Children's Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
| | - Krešimir Bulić
- 1Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Zagreb Children's Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
| | - Tomislav Luetić
- 1Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Zagreb Children's Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
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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: 0.8] [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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Sahu R, Goswamy B. A Comparative Study of Management of Femoral Shaft Fracture in Children: A Prospective Study. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2020. [DOI: 10.4103/jotr.jotr_15_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tisherman RT, Hoellwarth JS, Mendelson SA. Systematic review of spica casting for the treatment of paediatric diaphyseal femur fractures. J Child Orthop 2018; 12:136-144. [PMID: 29707052 PMCID: PMC5902747 DOI: 10.1302/1863-2548.12.170201] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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 Paediatric femur fractures are commonly encountered and often successfully managed with spica casting. Despite spica casting's long history there is little formal guidance for optimal outcomes and no consolidation of existing literature. The purpose of this study is to review the available literature regarding the use of spica casting for the management of paediatric diaphyseal femur fractures. METHODS The PubMed database was queried for all research articles including the phrase "spica". A total of 788 abstracts were reviewed for relevance to the current study. Data was extracted from all available research studies which specified tolerance for fracture angulation or shortening in the cast. Additionally, all articles describing alternative materials, methods for spica application, and complications of spica casting were reviewed. RESULTS In all, 106 articles were found relevant to the management of diaphyseal femur fractures in the paediatric population. The aggregated, accepted fracture shortening decreased from 16 mm to 18 mm before age ten years to 12 mm to 14 mm after puberty. Aggregated, accepted angulation decreased from 14° to 16° varus/valgus and 18° to 22° pro/recurvatum before age two years, to 6° to 8° and 10° to 12° by puberty, respectively. The overall reported complication rate was 19.6%, with the most common complication being skin compromise in 8.2% of patients, followed by unacceptable angulation at the fracture site in 4.2% of patients and excessive limb shortening in 1.9% of patients. CONCLUSION This article reviews the available spica casting literature and compiles the available data. Spica casting offers a safe, effective means for definitive management of paediatric diaphyseal femur fractures. Future research identifying the rate and pattern of remodelling as it relates to angulation and shortening at various patient ages, particularly beyond the aforementioned norms, would be valuable to identify true biological tolerances versus accepted expert opinion. LEVEL OF EVIDENCE LEVEL II Review of level II evidence.
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Affiliation(s)
- R. T. Tisherman
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA, Correspondence should be sent to R. T. Tisherman, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave Suite 911, Pittsburgh, Pennsylvania 15213, United States. E-mail:
| | - J. S. Hoellwarth
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - S. A. Mendelson
- Division of Orthopaedic Surgery, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
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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: 12] [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: 02/04/2023] 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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11
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Kumar S, Anand T, Singh S. Comparative Study Using Intramedullary K-wire Fixation Over Titanium Elastic Nail in Paediatric Shaft Femur Fractures. J Clin Diagn Res 2014; 8:LC08-10. [PMID: 25584251 PMCID: PMC4290322 DOI: 10.7860/jcdr/2014/9687.5119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 09/09/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fracture shaft femur is common paediatric trauma leading to significant morbidity. Conservative treatments available are associated with prolonged periods of immobilization. Use of flexible intramedullary implant allows early rehabilitation in diaphyseal fractures of femur in children. AIM The aim of the present study is to compare fixation of diaphyseal femur fracture by titanium elastic nail and intramedullary K-wires in children. SETTING AND DESIGN Prospective randomized study in a tertiary care hospital. MATERIAL AND METHODS Fifty-two children between 6 years and 14 years of age with femoral shaft fracture were assigned either in Group I or Group II based on computer generated random numbers. In Group I closed percutaneous intramedullary K- wire fixation and in Group II closed percutaneous intramedullary titanium elastic nail was used to fix the fractures. Partial weight bearing was allowed after 6 weeks of surgery and full weight bearing at clinico-radiological union. RESULTS Average time of radiological union was 6 to 10 weeks in both groups. In both the groups two cases had entry site irritation which resolved with early implant removal. One case in both the groups had unacceptable mal-alignment. Both the groups had few cases of limb-length discrepancy, which was in acceptable limit, except two cases of TENS. There was no statistically significant difference between the results of both the groups. But, using K-wires significantly reduced the cost of treatment. CONCLUSION Most of such fractures in our society are neglected because of high cost of treatment. Providing a cheaper alternative in form of K-wires may be beneficial for the patients from low socio-economic status.
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Affiliation(s)
- Sanjiv Kumar
- Assistant Professor, Department of Orthopaedics, Era,s Lucknow Medical College & Hospital, Lucknow, UP, India
| | - Tushar Anand
- Junior Resident, Department of Orthopaedics, Era,s Lucknow Medical College & Hospital, Lucknow, UP, India
| | - Sudhir Singh
- Professor & Head, Department of Orthopaedics, Era,s Lucknow Medical College & Hospital, Lucknow, UP, India
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Rahimi H, Gharehdaghi M, Birjandinejad A, Mirkazemi M, Azimi H. Comparison Between Closed (Immediate Spica, Traction/Spica Cast) and Open Fixation (Plate Fixation) in Femoral Shaft Fractures in Children Below Nine Years Old Who Had Recoursed to Mashhad Imam Reza Hospital From 2002 to 2007. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2013. [DOI: 10.17795/rijm14234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Comparison Between Closed (Immediate Spica, Traction/Spica Cast) and Open Fixation (Plate Fixation) in Femoral Shaft Fractures in Children Below Nine Years Old Who Had Recoursed to Mashhad Imam Reza Hospital From 2002 to 2007. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2013. [DOI: 10.5812/rijm.14234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
PURPOSE OF REVIEW Femoral fractures in children are the commonest children's fracture requiring hospitalization. They consume disproportionate amounts of healthcare resource. Advances in operative management have resulted in improved clinical and health economic outcomes. RECENT FINDINGS This article describes 21st-century management of femoral fractures concentrating on recent advances. There is a clear trend to increased operative management in all femoral fractures with improved outcomes in the proximal femur and shaft. Crucially, advances in the treatment of both have led to a reduction in the rate of avascular necrosis of the femoral head. SUMMARY Units treating paediatric fractures need access to specialist surgeons and equipment to treat the full range of femoral fractures and improve outcomes.
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