Developments in the Treatment of Pediatric Long Bone Shaft Fractures

Lieber, Justus; Schmittenbecher, Peter

doi:10.1055/s-0033-1360460

Cited by 36 publications

(12 citation statements)

References 52 publications

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“…Two main surgical techniques have been reported to be effective in treating tibial shaft fractures in skeletally immature children: internal fixation (elastic nails and screws) and external fixation. 5 , 6 Screw internal fixation is a suitable option, but is not stable enough to be used alone and requires supplemental long leg cast application. Elastic stable intramedullary nailing (ESIN) has been commonly used since it provides stability, flexible mobility and is usually performed by closed reduction.…”

Section: Introductionmentioning

confidence: 99%

Paediatric tibial shaft fractures treated by open reduction and stabilization with monolateral external fixation

Simon

Apostolou

Vidal

et al. 2018

Journal of Children's Orthopaedics

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PurposeElastic stable intramedullary nailing is increasingly used for surgical treatment of tibial shaft fractures, but frequently requires immobilization and delayed full weight-bearing. Therefore, external fixation remains interesting. The aim was to report clinico-radiological outcomes of monolateral external fixation for displaced and unstable tibial shaft fractures in children.MethodsAll tibial fractures consecutively treated by monolateral external fixation between 2008 and 2013 were followed. Inclusion criteria included skeletal immaturity and closed and open Gustilo I fractures caused by a direct impact. Patients were seen until two years postoperatively. Demographics, mechanism of injury, surgical data and complications were recorded. Anteroposterior and lateral side radiographs were performed at each visit. Full-limb 3D reconstructions using biplanar stereroradiography was performed for final limb length and alignment measures.ResultsA total of 45 patients (mean age 9.7 years ± 0.5) were included. In all, 17 were Gustilo I fractures, with no difference between open and closed fractures for any data. Mean time to full weight bearing was 18.2 days ± 0.7. After 15 days, 39 patients returned to school. Hardware removal (mean time to union 15.6 weeks ± 0.8) was performed during consultation under analgesic gas. There were no cases of nonunion. No fracture healed with > 10° of angulation (mean 5.1° ± 0.4°). Leg-length discrepancy > 10 mm was found for six patients.ConclusionsThis procedure can be a safe and simple surgical treatment for children with tibial shaft fractures. Few complications and early return to school were reported, with the limitations of non-comparative study.Level of EvidenceIV

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Section: Introductionmentioning

confidence: 99%

Paediatric tibial shaft fractures treated by open reduction and stabilization with monolateral external fixation

Simon

Apostolou

Vidal

et al. 2018

Journal of Children's Orthopaedics

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“…However, close monitoring during follow-up is mandatory, since reduction loss may occur, especially in unstable fracture types. This is also true for other pediatric long bone fractures that are treated non-operatively [10] . After reduction and casting of a long bone fracture, angulation of the fractured segments is measured to determine if the reduction is acceptable.…”

Section: Discussionmentioning

confidence: 95%

Use of a smartphone application for fracture angulation measurement

Ketencı¹

2018

Haydarpasa Numune Med J

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Introduction: After reduction and casting of pediatric long bone fractures, angulation of the fractured segments is measured to determine if the reduction is acceptable. The aim of the present study was to assess the reliability of a smartphone application (iPinPoint) for measurement of pediatric forearm diaphyseal fracture angulations with reference to picture archive and communication systems (PACS) software measurements. Methods: Anteroposterior and lateral forearm radiographs of 30 patients were retrospectively analyzed. Four observers measured the radius fracture angulations using the tools in the PACS software and a smartphone application. The inter-and intraobserver reliability was measured using intraclass correlation coefficients (ICCs). Results: Very good interobserver reliability was seen among the four observers measuring the angulations on anteroposterior and lateral radiographs using the PACS software (ICC 0.962 and 0.974, respectively) and iPinPoint (ICC 0.933 and 0.959, respectively). Intraobserver reliability was also very good for both techniques for all observers (ICC >0.9 for all observers). Discussion and Conclusion: Both techniques are reliable in measuring fracture angulations. The iPinPoint application may represent a useful alternative to digital PACS measurements when measuring tools are not available.

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“…Now it is clear that the trend of using operative treatment is connected to the perennial trend of considerable sociodemographic and socioeconomic changes in urban societies such as Zagreb. Lifestyle changes directly affect the prevalence of femur fractures among children, and also the approach to treatment choice 48 . Heideken et al showed a 20-year decreasing trend in the prevalence of femur fracture (about three percent annually) in Swedish children 49 .…”

Section: Discussionmentioning

confidence: 99%

Treatment of Pediatric Femoral Fractures in the City of Zagreb

Antabak

Boršćak

Čagalj

et al. 2020

ACC

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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. Nonoperative 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)(2011)(2012)(2013)(2014)(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 ...

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Developments in the Treatment of Pediatric Long Bone Shaft Fractures

Cited by 36 publications

References 52 publications

Paediatric tibial shaft fractures treated by open reduction and stabilization with monolateral external fixation

Paediatric tibial shaft fractures treated by open reduction and stabilization with monolateral external fixation

Use of a smartphone application for fracture angulation measurement

Treatment of Pediatric Femoral Fractures in the City of Zagreb

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