External fixation of pediatric femoral shaft fractures

Wani, Mubashir Maqbool; Dar, Reyaz Ahmad; Latoo, Irfan A.; Malik, Tariq; Sultan, Asif; Halwai, Manzoor Ahmed

doi:10.1097/bpb.0b013e32836421ce

Cited by 15 publications

(7 citation statements)

References 37 publications

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“…Previous studies showed that external fixation demonstrated results comparable with other fixation methods [7–9]. One of the major complications of external fixation is refracture after removal of the external fixator [8, 10–12]. In previous reports, rates for refracture varied from 0 to 21.6% [8, 12, 13].…”

Section: Discussionmentioning

confidence: 99%

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Recurrent femoral shaft fractures in a child with gnathodiaphyseal dysplasia: a case report

Kuroda

Okano

Sawada

et al. 2019

BMC Musculoskelet Disord

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Background Gnathodiaphyseal dysplasia (GDD) is an extremely rare autosomal dominant disease characterized by cemento-osseous lesions in the jawbones, bone fragility, and diaphyseal sclerosis of the tubular bones. Patients with GDD are prone to sustain fractures by minor accidents. Although over 80 cases have been reported, detailed information about the orthopedic treatment of the fractures is limited. Case presentation A 9-year-old Japanese girl with a known history of GDD presented with pain and deformity in the left thigh after a minor fall. She had a displaced transverse fracture in the mid-shaft of the left femur and underwent a closed reduction and external fixation. In the 25th week after the initial surgery, she had another fracture in the left femur at one of the half-pin insertion sites. She underwent an external fixation again. After this operation, the patient sustained another refracture at the same fracture site and one supracondylar fracture at the distant site of the femur. The supracondylar fracture occurred without any triggering activity before beginning a weight-bearing exercise. The supracondylar fracture was successfully treated conservatively, but she sustained two more diaphyseal fractures at half-pin insertion sites one after another. She eventually underwent a revision surgery with a flexible intramedullary nail. At 3 months postoperatively, the fracture was healed and the patient maintained her ambulatory status without further refracture. Conclusions Patients with GDD might have narrower safety ranges of biomechanical and physiological drawbacks, which are considered to be acceptable in ordinary cases. The choice of treatment should be aimed at minimizing these negative effects. We recommend intramedullary devise as the first-choice implant for the treatment of isolated femoral shaft fracture in GDD patients in this age group.

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Section: Discussionmentioning

confidence: 99%

“…One of the major complications of external fixation is refracture after removal of the external fixator [8, 10–12]. In previous reports, rates for refracture varied from 0 to 21.6% [8, 12, 13]. In their case series, Carmichael et al [8] described that longer time in fixator was one of the risk factors for refracture.…”

Section: Discussionmentioning

confidence: 99%

Recurrent femoral shaft fractures in a child with gnathodiaphyseal dysplasia: a case report

Kuroda

Okano

Sawada

et al. 2019

BMC Musculoskelet Disord

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“…Refracture is the main complication of external fixator application (6,7,10). However, removal of the external fixator after healing of four cortices instead of three will prevent this risk (14).…”

Section: Discussionmentioning

confidence: 99%

Comparison of efficiency between submuscular plating and external fixation of spiral and comminuted fractures of the femur in 6-12 years old pediatric patients

Dırvar¹,

Tunç²,

Cengîz³

et al. 2016

Sisli Etfal

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Comparison of efficiency between submuscular plating and external fixation of spiral and comminuted fractures of the femur in 6-12 years old pediatric patients Objective: The treatment of femoral diaphyseal fractures in children 6 to 12 years of age has changed substantially over the last two decades and continues to evolve. Although external fixation and submuscular plating have been extensively used in the management of pediatric femur fractures, there are few studies which have compared the results of external fixation and submuscular bridge plating in pediatric closed unstable spiral femoral diaphyseal fractures. Material and Method: Two groups of patients treated by external fixator or submuscular plating due to femoral diaphyseal spiral and comminuted fractures were included in our study. Twenty patients comprised the external fixation group and 26 patients the submuscular bridge plating group. The patients were evaluated for mechanism of injury, knee ROM, length of hospital stay, clinical and radiological findings and complications. The average follow-up period was 2 (range: 1.5 to 4) years. Results: Age of the patients ranged from 6 to 11 (average: 7.45) years in the external fixator group and from 7 to 12 (average: 9.08) years in the submuscular plating group. In the external fixator group, the fixator was removed at an average of 12.2 weeks. In the submuscular plating group, radiographic union was detected at an average time of 10 weeks. Pin site infection was common in the external fixator group. Patients were given knee ROM rehabilitation for knee contracture. No refracture was observed in the external fixator and submuscular plating groups. Conclusion: The main point to consider in external fixator use in pediatric femur fractures is refracture after fixator removal, which is mostly seen in transverse and open fractures. Use of the external fixator in spiral fractures and removing the fixator following bone healing in four cortices may prevent refracture complication. It is the surgeon's choice to decide between the two treatment modalities to operate on the femur fracture. Although we found similar results between external fixator and plate in pediatric femur shaft fractures; we think large population based studies are needed in order to comparison. ÖZET:6-12 yaş arası pediatrik spiral ve parçalı femur kırıklarında submuskuler plaklama ve eksternal fiksatör uygulaması etkinliği karşılaştırılması Amaç: 6-12 yaş Pediatrik femur cisim kırıklarının tedavisi son yirmi yılda kayda değer bir gelişme göstermiş olup, bu gelişim devam etmektedir. Pediatrik femur cisim kırıklarının tedavisinde eksternal tespit ve submusküler plak uygulamasına yaygın bir şekilde başvurulsa da, pediatrik kapalı instabil spiral femur cisim kırıklarında eksternal tespit ve submusküler köprü-plak uygulamalarının karşılaştırıldığı çalışma sayısı oldukça azdır. Gereç ve Yöntem: Çalışmamıza femur cisim spiral ve parçalı kırıklar nedeniyle eksternal fiksatör veya submüsküler plak uygulaması ile tedavi edilen 2 grup hasta dahil edildi. ...

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“…Many previous reports have described the management of diaphyseal femoral fractures in normal children. However, no clear consensus has been reached on the best way to treat diaphyseal femoral fractures in normal children [10-12]. Kapukaya et al [13] reported that external fixation in closed femoral shaft fractures in children could be a rational alternative mode of therapy because it has some advantages and can be easily removed without undergoing a second round of anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Pathological fracture of the femur in Alagille syndrome that was treated with low-intensity pulsed ultrasound stimulation and an Ilizarov ring fixator: a case report

Nozaka

Shimada

Miyakoshi

et al. 2014

BMC Musculoskelet Disord

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BackgroundAlagille syndrome is a multisystem disorder, which is characterized by hypoplasia of the intrahepatic bile ducts, malformations of the cardiovascular system, eyes, and vertebral column, and abnormal facies. Several of the characteristics of Alagille syndrome may result in an especially high risk of fracture. The majority of patients suffer from chronic cholestasis, which can have a variety of adverse effects on bone metabolism. In Alagille syndrome, fractures primarily occur in the lower limb long bones in the absence of significant trauma.Case presentationA 9-year-old Japanese girl with Alagille syndrome was admitted to our institution with marked hyperbilirubinemia and a pathological fracture of the femur. She had been diagnosed with biliary atresia at the age of 1 month and treated with surgical bile duct reconstruction, vitamins D and K, and ursodeoxycholic acid. However, her liver dysfunction and hyperbilirubinemia worsened. The pathological fracture of the femur was treated with low-intensity pulsed ultrasound stimulation (LIPUS) and an Ilizarov ring fixator. Seventy-four days after surgery, the patient had anatomically and functionally recovered. There was no leg-length discrepancy and no angular malalignment of the lower extremities as measured clinically and radiographically. The range of motion of the hip, knee, and ankle of the patient’s operative leg matched the range of motion in the nonoperative leg.ConclusionTo the best of our knowledge, there are no reports on use of the Ilizarov frame and LIPUS in diaphyseal femoral fractures in Alagille syndrome. This case report provides evidence that this procedure is successful for managing such diaphyseal fractures in Alagille syndrome.

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External fixation of pediatric femoral shaft fractures

Cited by 15 publications

References 37 publications

Recurrent femoral shaft fractures in a child with gnathodiaphyseal dysplasia: a case report

Recurrent femoral shaft fractures in a child with gnathodiaphyseal dysplasia: a case report

Comparison of efficiency between submuscular plating and external fixation of spiral and comminuted fractures of the femur in 6-12 years old pediatric patients

Pathological fracture of the femur in Alagille syndrome that was treated with low-intensity pulsed ultrasound stimulation and an Ilizarov ring fixator: a case report

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