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

Kruppa, Christiane; Wiechert, Gabriele; Schildhauer, Thomas A.; Dudda, Marcel

doi:10.4081/or.2017.7493

Cited by 6 publications

(4 citation statements)

References 29 publications

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“…Reasons for these differences could be related to population differences and differences in regional surgical practice and trends. Overall the high rate of reoperation (15.9%) found among adolescents surgically treated for midshaft clavicle fractures is similar to the reoperation rate reported by Kruppa et al [ 18 ] among children and adolescents surgically treated for femoral shaft fractures (14.3%).…”

Section: Discussionsupporting

confidence: 87%

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

Carrillo¹,

Wu²,

Chopra³

et al. 2021

WJO

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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.

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Section: Discussionsupporting

confidence: 87%

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

Carrillo¹,

Wu²,

Chopra³

et al. 2021

WJO

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“…The interlocking intramedullary nails themselves have stress shielding, which can cause complications such as delayed bone healing or nonunion. Some studies have shown that [17], in adolescents with an average weight of 72 kilograms (53 to 99) and an average age of 15 years (14 to 16) who use interlocking intramedullary nails for femoral shaft fractures, one-third of patients have complications such as wound infection and bone nonunion. The study of Martus et al [8] shown some patients use locked intramedullary nail to treat long-term pain after femoral shaft fractures.…”

Section: Resultsmentioning

confidence: 99%

Efficacy analysis of treatment of femoral shaft fractures in adolescents with elastic intramedullary nail

Sun,

Liang,

Wang

et al. 2023

Preprint

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Objective To investigate the clinical efficacy of treatment of femoral shaft fractures in adolescents with elastic intramedullary nail. Methods From March 2016 to January 2022, the data of 59 cases of adolescent femoral shaft fractures treated by elastic intramedullary nail in the Pediatric Orthopaedic Hospital, Honghui Hospital, Xi’an Jiaotong University were analyzed retrospectively. We were able to follow-up on 59 patients (34 males, 25 females); Mean age at fracture was 13 (11 ~ 18) years; Body weight: 38 ~ 62kg, average 48kg. The time from injury to surgery ranged from 2 to 7 days. The average was 3.8 days. All operations were fixed with elastic intramedullary nails, and external fixation was fixed with hip herringbone plaster or brace. Record the operation time, intraoperative blood loss, diameter of elastic intramedullary nail, external fixation method, hospital stay, fracture healing time, etc. Results Surgery took 60 ~ 180 minutes, with an average of 110 minutes. Intraoperative blood loss: 5 ~ 30ml, average 14ml. Elastic intramedullary nail diameter: Of these, 24 patients used 4.0mm; 35 patients used 3.5mm. External fixation: hip herringbone plaster fixation in 45 cases; 14 cases were fixed with brace. Patients were hospitalised for 4 ~ 14 days, averaging 7 days. Mean post-operative follow-up of 18 months (12–36 months). The fracture healing time was 3 to 8 months (average 4.6 months). The internal fixation was taken out from 11 to 20 months after operation, with an average of 13 months. During the follow-up period, no patient had complications such as femoral head necrosis, infection, nonunion of fracture, delayed union, malunion and nail withdrawal. At the last follow-up, the lower limbs of two patients were not equal in length, but the difference was less than 1 cm. Conclusions The treatment of femoral head fractures in adolescents with flexible intramedullary nailing is simple, with less bleeding, fewer complications, less impact on limb development, and definite efficacy.

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“…Although union rate was reported up to 100% with a shorter hospital stay; however, it carries the risk of increased blood loss and the need for other surgery for plate removal [7] , [8] , [9] . In a study by Kruppa et al reporting on a cohort of children and adolescents treated for femoral shaft fractures using various methods, the authors reported an overall incidence of complications of 16.7%, 4.8% deep infection and 2.4% non-union, nearly all the complicated cases needed re-operation, hardware removal was performed in about 91% of the patients [10] .…”

Section: Discussionmentioning

confidence: 99%

Single stage open reduction, intramedullary rod, bone grafting, and plate fixation for managing adolescent midshaft femoral fracture non-union, report of two cases

Refai

Khalifa

2022

Trauma Case Reports

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Although rare, long bones fracture non-union in pediatric and adolescent patients is still being reported. It poses a challenge for the trauma surgeons, although principles for adult patient management apply to pediatrics and adolescents; however, there is no standard protocol to deal with such situations. We report two male adolescent patients, 11 and 12 years old, presented with non-united midshaft femoral fracture non-union after being multiply operated on. One patient was diagnosed with a septic non-union, while the other had an atrophic type. Both were treated following the same technique of open surgery where debridement and refreshing of the fracture site were performed, followed by initial fixation using an intramedullary rod, the biological environment was then enhanced by the addition of autologous iliac bone graft, and the fixation was finalized using a 4.5 dynamic compression plate. Both patients achieved complete fracture union and excellent functional outcomes by the last follow up. Adolescent patients presented with multiply operated non-united femoral fracture could be successfully treated using the described technique. It improves the mechanical and biological environment with the advantage of being a single-stage surgery.

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

Cited by 6 publications

References 29 publications

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

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

Efficacy analysis of treatment of femoral shaft fractures in adolescents with elastic intramedullary nail

Single stage open reduction, intramedullary rod, bone grafting, and plate fixation for managing adolescent midshaft femoral fracture non-union, report of two cases

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