Fixator-Assisted Plating in Pediatric Supracondylar Femur Fractures

Displaced supracondylar femoral fractures: Clinical and radiographic outcomes in children aged 4-10 years treated with Kirschner wires and hip spica cast

BACKGROUND

Supracondylar femoral fractures (SFFs) are uncommon in children but can cause several abnormalities. Although several methods have been employed to treat these fractures, no accepted standard has been established.

OBJECTIVES

To investigate the clinical and radiographic outcomes of displaced SFFs treated with Kirschner wires (K-wires) and hip spica casts in children aged 4-10 years.

METHODS

We retrospectively reviewed 22 displaced SFFs (mean age, 6.7 years; range, 4-10 years) in patients who underwent surgical treatment with K-wires and hip spica casts. The patients were followed-up frequently, radiographically and clinically between January 2014 and February 2019. Postoperative healing and functional results were elevated according to the radiographic and clinical measures.

RESULTS

Fifteen boys and seven girls were included in this study. All patients except two (91%), underwent closed reduction and stabilization of the fractures. The mean follow-up duration was four years (range, 2-5 years). All fractures showed clinical and radiological evidence of union 4-8 weeks after surgery. At the most recent check-up, all patients reported being pain-free and had returned to normal activities. The mean Knee Society Score was 95.41 at the final follow-up. According to the radiologic criteria, 18 of the 22 patients (81.8%) obtained excellent results, 3 (13.6%) had good results, 1 (4.5%) had a fair result, and none had poor results.

CONCLUSION

Satisfactory clinical and radiological results can be expected in children aged 4-10 years using a combination of K-wires and hip spica cast fixation.

Hybrid Fixation for Paediatric Femoral Supracondylar Fracture during Circular External Fixation of the Lower Limb

Aim

To describe the novel hybrid fixation technique for paediatric femoral supracondylar fracture during circular external fixation of the lower limb.

Background

The Ilizarov external fixator is commonly used for various orthopaedic conditions. Difficulties associated with external fixation have previously been described. A fall while using a circular external fixator can cause ipsilateral fracture. Such fractures are ideally treated conservatively, but it is difficult to fix the frame itself. No study has reported the treatment of paediatric femoral supracondylar fracture during circular external fixation. Herein, we describe a novel hybrid fixation technique that was successfully used to treat paediatric femoral supracondylar fracture in three paediatric patients with circular external fixators.

Technique

The fracture was manually manipulated and reduced by slight hyperextension of the lower extremity under general anaesthesia. After confirmation of good reduction, a stockinette, a cast padding, and a thin core cast were applied to the ipsilateral thigh. The hinge parts were attached to the medial and lateral sides of the proximal ring. The rods were connected to the medial and lateral hinges, and the half ring was connected to the ventral side of the proximal end. Under fluoroscopic confirmation, the thin core cast of the thigh and rods were connected by cast rolled in a figure-of-eight manner. The hinges were locked with the knee joint slightly flexed.

Conclusion

The minimally invasive hybrid fixation technique enables conservative treatment of paediatric femoral supracondylar fracture during circular external fixation of the lower limb with no complications, and early exercise and recovery.

Clinical significance

This novel hybrid fixation technique will be an effective method for paediatric femoral supracondylar fracture in patients with a circular external fixator.

How to cite this article

Oka Y, Kim W-C, Yoshida T, et al. Hybrid Fixation for Paediatric Femoral Supracondylar Fracture during Circular External Fixation of the Lower Limb. Strategies Trauma Limb Reconstr 2020;15(3):179–183.

Locking plate versus external fixation in the treatment of displaced femoral supracondylar fracture in children

BACKGROUND

Displaced supracondylar femoral fractures (SFF) are difficult injuries to treat in children. Several techniques have been widely used but few studies have compared the merits and drawbacks of each surgical intervention in order to analyze clinical values. The aim of this study was to (1) evaluate postoperative and functional conditions after treatments with locking plate (LP) or external fixation (EF), (2) observe adverse events associated with these two techniques, and (3) evaluate the clinical value of these two techniques.

METHODS

Twenty-eight patients less than 14 years of age were included in this study with supracondylar femoral fractures. They underwent locking plate or external fixation in authors' hospital. The postoperative healing and functional outcome were elevated according to radiographic and clinical measures, including American Knee Society Score (KSS). Fisher's exact test and independent samples t test were used for statistical analysis.

RESULTS

All fractures healed without delayed union. The KSS scoring results of locking plate and external fixation groups were both excellent. The alignment of lower limbs was acceptable with knee valgus less than 2° for all involved patients. In addition, leg length discrepancy was less than 1 cm. No acute or severe complications were noted. There was significant difference in union time (p = 0.03), operating time (p< 0.001), intraoperative blood loss (p< 0.001), and limb length discrepancy (p = 0.04) between LP group and EF group.

CONCLUSIONS

External fixation is superior than locking plate in terms of union, operation time phrases, and intraoperative blood loss. EF techniques are better options for treating displaced supracondylar femoral fracture in children.

LEVEL OF EVIDENCE

Retrospective comparative study; level III.