Complications after operative treatment of femoral shaft fractures in childhood and adolescence

Developmental delay: is this pediatric patient population at risk for complications following open treatment of femoral shaft fracture?

PURPOSE

Femoral shaft fractures are common in the pediatric population, accounting for over 20% of inpatient pediatric fractures. Patients with developmental delays are a population group whose medical care and recovery come with a unique set of considerations and challenges. The purpose of this study was to evaluate the impact of developmental delay on outcomes following open treatment of femoral shaft fractures in the pediatric population.

METHODS

Pediatric patients undergoing open treatment of femoral shaft fracture from 2012 to 2019 were identified in the National Surgical Quality Improvement Program-Pediatric database. Patients were divided into two groups: patients with developmental delay and patients without developmental delay. Patient demographics, comorbidities, and various postoperative outcomes were compared between the two groups using bivariate and multivariate analyses.

RESULTS

Of the 5896 pediatric patients who underwent open treatment of femoral shaft fracture, 5479 patients (92.9%) did not have developmental delay whereas 417 (7.1%) had developmental delay. Patients with developmental delay were more likely to have other medical comorbidities. Following adjustment on multivariable regression analysis to control for the baseline differences between the two groups, patients with developmental delay had an increased risk of readmission to the hospital (OR 4.762; p = 0.014).

CONCLUSION

Developmental delay in the pediatric population was found to be an independent risk factor for hospital readmission following open treatment of femoral shaft fractures. Taking these patients into special consideration when evaluating the optimal treatment plan can be beneficial to reduce the risks of readmission, which can decrease costs for both the patient and the hospital.

Rates of readmission and reoperation after operative management of midshaft clavicle fractures in adolescents

BACKGROUND

The national rates of readmission and reoperation after open reduction internal fixation (ORIF) of midshaft clavicle fractures in adolescents is unknown.

AIM

To determine rates of and risk factors for readmission and reoperation after ORIF of midshaft clavicle fractures in adolescents.

METHODS

This retrospective study utilized data from the Healthcare Cost and Utilization Project State Inpatient Database for California and Florida and included 11728 patients 10–18 years of age that underwent ORIF of midshaft clavicle fracture between 2005 and 2012. Readmissions within ninety days, reoperations within two years, and differences in patient demographic factors were determined through descriptive, univariate, and multivariate analyses.

RESULTS

In total, 3.29% (n = 11) of patients were readmitted within 90 d to a hospital at an average of 18.91 ± 18 d after discharge, while 15.87% (n = 53) of patients underwent a reoperation within two years at an average of 209.53 ± 151 d since the index surgery. The most common reason for readmission was a postoperative infection (n < 10). Reasons for reoperation included implant removal (n = 49) at an average time of 202.39 ± 138 d after surgery, and revision ORIF (n < 10) with an average time of 297 ± 289 d after index surgery. The odds of reoperation were higher for females (P < 0.01) and outpatients (P < 0.01), while the odds of reoperation were lower for patients who underwent surgery in California (P = 0.02).

CONCLUSION

There is a low rate of readmission and a high rate of reoperation after ORIF for midshaft clavicle fractures in adolescents. There are significant differences for reoperation based on patient sex, location, and hospital type.

Simultaneous Bilateral Femur Fractures in Children: A Case Series from a Pediatric Level I Trauma Center and Review of the Literature

BACKGROUND

Bilateral femur fractures are rare in the pediatric population with few cases reported in the literature. The purpose of this study was to review our institutional experience with a case series of simultaneous bilateral femur fractures to highlight the presentation, treatment, and outcomes of these rare injuries as well as perform a preliminary comparison to similar unilateral femur fractures in order to identify any clinically relevant differences that may guide future management.

METHODS

We undertook a retrospective chart review of patients who had presented with simultaneous bilateral femur fractures between 2007 and 2017 with a minimum of 1-year of follow-up. Descriptive information was provided about the case series of bilateral femur fracture patients with subsequent further analysis comparing unilateral and bilateral femur fractures.

RESULTS

Eight patients (7 males, 1 female) were identified after chart review. Mean age at the time of injury was 11 years (8 to 15 years). Mechanism of injury was high energy trauma in 7 of 8 patients. Six of 8 patients presented with at least one significant associated injury. All patients underwent operative fixation bilaterally. Average length of stay was 12 days (range 4-27 days). Four patients required admission to inpatient rehab facility. Complete healing occurred in all patients. One patient experienced unilateral genu valgum deformity treated successfully with growth modulation. Another patient experienced a unilateral bony bar of approximately 20% of the physis which did not result in angular deformity or limb length discrepancy. After comparing to a matched unilateral femur fracture cohort, we found that patients who sustained bilateral femur fractures had a significantly higher number of associated injuries as well as greater length of stay (p<0.05). There was no statistical difference in complications.

CONCLUSIONS

Our case series illustrates the presentations and outcomes of this rare injury pattern in children along with a few potential differences that distinguish bilateral femur fractures from unilateral fractures. These results may help guide healthcare personnel in making management decisions regarding this rare injury.Level of Evidence: IV.

Comparison of efficacy between internal fixation of minimally invasive elastic stable intramedullary nail and plate in the treatment of pediatric femoral shaft fracture

Objective:

To compare and analyze the clinical effects of internal fixation of minimally invasive elastic stable intramedullary nail and plate in the treatment of pediatric femoral shaft fracture.

Methods:

A total of 120 children with femoral shaft fractures who were admitted to our hospital from December 2016 to April 2018 were enrolled. The children were divided into an observation group and a control group by random number table, with 60 children in each group. The children in the observation group underwent internal fixation of minimally invasive elastic stable intramedullary nail, while those in the control group underwent open reduction based on internal fixation of plate. The surgical status and postoperative complications of the two groups were observed and compared, and Kolmert knee function scoring criteria were used for assessing the surgical effects of children.

Results:

The operation duration, intraoperative blood loss, hospitalization duration, fracture healing time and time of off-bed loaded activity of the observation group were significantly shorter than those of the control group, and the differences were statistically significant (P<0.05). The excellent and good rate of fracture healing in the observation group was 100%, which was higher than that of the control group, 83.33%, and the difference was statistically significant (P<0.05). The total incidence rate of complications in the observation group was 8.33%, which was lower than that of the control group, 10.00%, but the difference was not statistically significant (P>0.05).

Conclusion:

Pediatric femoral shaft fractures can be treated with internal fixation of minimally invasive elastic intramedullary nail, and it has advantages of significant curative effect, small trauma and fast postoperative recovery, which is conducive to fracture healing and worth promoting.