Current Concepts in Paediatric Femoral Shaft Fractures

John, Rakesh; Sharma, Sudhaa; Gn, Raj; Singh, Jaspreet; A, Rhh; Khurana, Ananta

doi:10.2174/1874325001711010353

Cited by 34 publications

(40 citation statements)

References 104 publications

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“…FIMN of the pediatric femur, which is synonymous with both titanium elastic nailing and elastic stable intramedullary nailing, provides immediate-to-early stability to the involved bone segment, permitting early mobilization and allows for return to normal activities with a relatively low complication rate[ 17 ]. Although FIMN is an effective procedure for length stable diaphyseal pediatric femoral fractures, there is concern regarding its use for length unstable fractures[ 8 , 9 , 14 , 18 - 21 ]. Potential complications with FIMN treatment for length unstable fractures include suboptimal stability leading to angulation, shortening, rotation[ 8 , 22 - 24 ], and nail protrusion resulting in symptomatic hardware with skin irritation being the primary patient complaint[ 6 , 16 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

Length unstable femoral fractures: A misnomer?

Mussell¹,

Jardaly²,

Gilbert³

2020

WJO

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BACKGROUND Flexible intramedullary nailing (FIMN) is relatively contraindicated for pediatric length unstable femoral fractures. AIM To evaluate FIMN treatment outcomes for pediatric diaphyseal length unstable femoral fractures in patients aged 5 to 13 years. METHODS This retrospective study includes pediatric patients (age range 5-13 years) who received operative treatment for a diaphyseal femoral fracture at a single institution between 2013 and 2019. Length unstable femur fractures treated with FIMN were compared to treatment with other fixation methods [locked intramedullary nailing (IMN), submuscular plating (SMP), and external fixation] and to length stable fractures treated with FIMN. Exclusion criteria included patients who had an underlying predisposition for fractures ( e.g ., pathologic fractures or osteogenesis imperfecta), polytrauma necessitating intensive care unit care and/or extensive management of other injuries, incomplete records, or no follow-up visits. Patients who had a length stable femoral fracture treated with modalities other than FIMN were excluded as well. RESULTS Ninety-five fractures from ninety-two patients were included in the study and consists of three groups. These three groups are length unstable fractures treated with FIMN ( n = 21), length stable fractures treated with FIMN ( n = 45), and length unstable fractures treated with either locked IMN, SMP, or external fixator ( n = 29). P values < 0.05 were considered statistically significant. Patient characteristic differences that were statistically significant between the groups, length unstable with FIMN and length unstable with locked IMN, SMP, or external fixator, were average age (7.4 years vs 9.3 years, respectively), estimated blood loss (29.2 mL vs 98 mL, respectively) and body mass (27.8 kg vs 35.1 kg, respectively). All other patient characteristic differences were statistically insignificant. Regarding complications, length unstable with FIMN had 9 total complications while length unstable with locked IMN, SMP, or external fixator had 10. Grouping these complications into minor or major, length unstable with locked IMN, SMP, or external fixator had 6 major complication while length unstable with FIMN had 0 major complications. This difference in major complications was statistically significant. Lastly, when comparing patient characteristics between the groups, length unstable with FIMN and length stable with FIMN, all characteristics were statistically similar except time to weight bearing (39 d vs 29 d respectively). When analyzing complication differences between these two groups (9 total complications, 0 major vs 20 total complications, 4 major)...

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Section: Introductionmentioning

confidence: 99%

Length unstable femoral fractures: A misnomer?

Mussell¹,

Jardaly²,

Gilbert³

2020

WJO

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“…2 Increased economic burden to the family and psychological impact to the children are highly associated with this type of injury. 3 Fractures are mostly caused by fall injury during play or physical abuses. Transverse fractures are caused by low velocity trauma whereas comminuted or segmental fractures are caused by high velocity trauma.…”

Section: Introductionmentioning

confidence: 99%

“…4 The management options for paediatric femoral shaft fractures include both nonoperative and operative techniques. 3 Previously most of the fractures were effectively managed nonoperatively and only unstable and displaced fractures were treated by various fixation techniques. Fractures treated non-operatively by traction followed by hip spica require prolonged hospitalization causing undue physical and psychological stress for patient and patient family.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Titanium Elastic Nailing in the Surgical Management of Femoral-Shaft Fracture in Children

2020

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Introduction: Femoral shaft fracture is one of the most common orthopedic injuries of the children. These fractures treated non-operatively by traction followed by hip spica require prolonged hospitalization causing undue physical and psychological stress for patient and patient family. Loss of reduction is also commonly seen with hip spica that leads to unacceptable complications like angular deformities and limb length discrepancies. Titanium Elastic Nailing (TEN) is becoming widely accepted treatment for femoral shaft fractures in children due to its simplicity and physeal protective stable load sharing construct that allows early mobilization. The purpose of this study was to see the outcome of operative treatment of femoral shaft fracture in children by TEN. Methods: A retrospective observational study was carried out in the Department of Orthopedics in National Academy of Medical Sciences, National Trauma Center from February 2017 to January 2019. Study was undertaken in 22 children between the age group of 5-14 years with femoral shaft fractures. Fixation with TEN was done for all fractures within nine days of injury. Patients were assessed radiologically as well as clinically until fractures healed. The results were evaluated using Flynn scoring criteria. Results: Radiological union was seen in all cases between 6–12 weeks after surgery. The mean operating time was 58 (48-115) minute and mean hospital stay after surgery was 9 (6-15) days. Results were excellent in 14 patients (63.63%), satisfactory in 6 patients (27.37%) & poor in 2 patients (9%). Six patients had skin irritation at nail insertion site which resolved after removal of nails. Functional range of motion in both hip and knee joints of affected limb was preserved in all cases after the removal of nails. Conclusion: TEN is an effective and safe treatment of femoral shaft fractures in children of 5-14 years of age group.

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“…External fixation is an option reserved for patients with poly-trauma or open fracture in children. 4 In non operative methods, spica casting is a gold standard for children under six years of age because of excellent bone union and remodeling qualities. It is most commonly used method of managing pediatric femur shaft fractures.…”

Section: Introductionmentioning

confidence: 99%

Frequency of limb shortening in femoral shaft fractures treated by hip spica casting in children in Tertiary Care Hospital.

Mehmood¹,

Shah²,

Razzaq³

2019

TPMJ

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Objectives: In non-operative methods, hip spica casting is a gold standard for children under six years of age because of excellent bone union and remodeling qualities. The study was conducted to determine the frequency of limb shortening in femur shaft fractures in children treated by hip spica casting. Study Design: Descriptive cross sectional study. Setting: Orthopedics Department of Combined Military Hospital, Rawalakot, Pakistan. Period: One year from July, 2016 to June, 2017. Material and Methods: After approval of the study from institution’s ethical committee, all patients fulfilling the inclusion criteria were admitted through emergency or outpatient department for hip spica casting. It was descriptive cross sectional study and sampling was done by non-probability convenience sampling in 107 femur fracture patients treated by hip spica casting. Diagnosis of the fracture was based upon history of trauma with break in the continuity of shaft as seen by X-ray. Informed consent was obtained from parents/guardian to be included in the study. Results: The mean age was 5(± 2.04) years. Sixty eight percent patients were male and 32% were female. Sixty three percent patients had proximal femoral shaft fracture, 32% had middle femoral shaft fracture and 4% patients had distal femoral shaft fracture. The shortening of limb length was found in14% of patients. Conclusion: In closed femoral shaft fractures, hip spica casting is a safe treatment in children. It has a low risk of complications. We recommend its use except for open fractures, multiple fractures, or fractures in older children.

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Current Concepts in Paediatric Femoral Shaft Fractures

Cited by 34 publications

References 104 publications

Length unstable femoral fractures: A misnomer?

Length unstable femoral fractures: A misnomer?

Outcome of Titanium Elastic Nailing in the Surgical Management of Femoral-Shaft Fracture in Children

Frequency of limb shortening in femoral shaft fractures treated by hip spica casting in children in Tertiary Care Hospital.

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