Femoral Fracture Treatment in Head-injured Children: Use of External Fixation

Porat, Shlomo; Milgrom, Charles; Nyska, Meir; Whisler, Jon H.; Zoltan, Jon D.; Mallin, Bruce A.

doi:10.1097/00005373-198601000-00015

Cited by 38 publications

(10 citation statements)

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“…The patients were treated with external fixation and healed with good alignment, length, and without infection. The authors concluded that external fixation was the optimal treatment for a fractured femur in the head-injured child who exhibits spasticity or seizures [11]. In a critical appraisal of the literature, Wright examined 15 studies that compared the results of two or more forms of treatment for femoral shaft fractures in children without cerebral palsy.…”

Section: Discussionmentioning

confidence: 99%

Treatment of femur fractures in children with cerebral palsy

Leet

Shirley

Barker

et al. 2009

Journal of Children's Orthopaedics

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Purpose Children with cerebral palsy may have low bone density stemming from various etiologies and are, thereby, at risk for fractures. The treatment of femur fractures in children with cerebral palsy may need to be tailored to address the management of spastic muscle tone and multiple medical co-morbidities. Methods Our study is a retrospective review that evaluates the treatment of 47 femur fractures in children with cerebral palsy in both ambulatory and non-ambulatory patients.Results Thirty-two fractures in non-ambulators were treated non-operatively, 11 of which resulted in malunions and five developed pressure sores. Six fractures in nonambulators were treated operatively, one of which resulted in a malunion. In ambulators, five fractures were treated non-operatively; one of these fractures lost reduction after 2 weeks and required surgical intervention. One of four fractures in ambulators treated operatively developed a malunion. Conclusion Our study results suggest that femur fractures in children with cerebral palsy can be treated non-operatively; however, because of the high risk of malunion in this patient population, fracture alignment needs to be followed closely during healing. Careful attention during casting is necessary to prevent pressure sores. Strong consideration should be given to initial operative treatment in ambulatory patients in order to preserve function.

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Section: Discussionmentioning

confidence: 99%

Treatment of femur fractures in children with cerebral palsy

Leet

Shirley

Barker

et al. 2009

Journal of Children's Orthopaedics

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“…Surgical treatment for femoral fractures in children used to be reserved for patients with head or multiple injuries or with severe soft-tissue damage, 3,10,20 but indications have Anteroposterior and lateral views of a femur treated by FIN, showing the reduction and early callus formation.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Surgical treatment was limited to open fractures or for patients with head or multiple injuries. [3][4][5] More recently, there has been a growing trend towards surgical treatment with widening of the indications to include isolated femoral fractures. 1,6 The methods have included external fixation, [7][8][9][10] compression plating 11,12 and intramedullary nailing with either rigid [13][14][15][16][17][18][19][20] or flexible nails.…”

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confidence: 99%

External Fixation or Flexible Intramedullary Nailing for Femoral Shaft Fractures in Children

Bar‐On

Sagiv

Porat

1997

The Journal of Bone and Joint Surgery. British volume

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We report the outcome of 19 children aged 5.2 to 13.2 years with 20 fractures of the femoral shaft requiring surgery, who were randomly assigned to have external fixation (EF) or flexible intramedullary nailing (FIN) (10 fractures each). The duration of the operation averaged 56 minutes for the EF group with 1.4 minutes of fluoroscopy, compared with 74 minutes and 2.6 minutes, respectively, for the FIN group. The early postoperative course was similar, but the EF group showed much more callus formation. The time to full weight-bearing, full range of movement and return to school were all shorter in the FIN group. The FIN complications included one transitory foot drop and two cases of bursitis at an insertion site. In the EF group there was one refracture, one rotatory malunion requiring remanipulation and two pin-track infections. At an average follow-up of 14 months two patients in the EF group had mild pain, four had quadriceps wasting, one had leg-length discrepancy of over 1 cm, four had malalignment of over 5°, and one had limited hip rotation. In the FIN group, one patient had mild pain and one had quadriceps wasting; there were no length discrepancies, malalignment or limitation of movement. Parents of the FIN group were more satisfied. We recommend the use of flexible intramedullary nailing for fractures of the femoral shaft which require surgery, and reserve external fixation for open or severely comminuted fractures.

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“…Waddell's triad of femoral fracture, intra-abdominal or intrathoracic injury, and head injury are associated with high-velocity automobile injuries. Multiple traumas may necessitate rapid stabilization of femoral shaft fractures 11,12 to facilitate overall care. This is particularly true with head injury and vascular disruption.…”

Section: Introductionmentioning

confidence: 99%

A Comparative study of the results of conservative treatment versus closed titanium elastic nailing for fractures of shaft of femur in children

Mukherjee

Gupta

2017

Asian J Med Sci

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Background:The ideal treatment of femoral shaft fracture in children is defined as one that controls alignment and length, is comfortable for child and convenient for family and causes the least psychological impact possible. Aims and Objective: The current study was designed to evaluate outcomes prospectively in the first year following treatment of a diaphyseal femoral fracture in children between five and ten years of age treated randomly either by intramedullary titanium elastic nailing or by traction followed by spica cast. Materials and Methods: Out of 48 cases selected according to inclusion/exclusion criteria 6 patients were lost to follow up. Among the rest of 42 patients, 23 were treated by intramedullary titanium elastic nailing and the other 19 conservatively by surface traction. The patients were evaluated at the regular interval of 2, 4, 6 and 8 th week post operatively and thereafter every month. Results: There was a significant difference (p< 0.001) in terms of mean hospital stay and mean weight bearing between the two study groups. The findings of outcome and maintenance of reduction, time taken for the evidence of union to appear, the range of movements, the time when weight bearing can be allowed, the functional return of the limb, the rate of complications and the number days of hospital stay were comparable to similar studies conducted earlier. Conclusion: The study concludes that closed pediatric femoral shaft fractures within the ages of 5-10 years can be treated successfully by any methods of traction followed by spica cast or intramedullary titanium elastic nailing. However, because of shorter immobilization period and earlier ambulation, internal fixation with titanium elastic nailing is recommended as the better choice to treat this fracture in school going children.

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Femoral Fracture Treatment in Head-injured Children: Use of External Fixation

Cited by 38 publications

References 0 publications

Treatment of femur fractures in children with cerebral palsy

Treatment of femur fractures in children with cerebral palsy

External Fixation or Flexible Intramedullary Nailing for Femoral Shaft Fractures in Children

A Comparative study of the results of conservative treatment versus closed titanium elastic nailing for fractures of shaft of femur in children

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