Fixation of Length-Stable Femoral Shaft Fractures in Heavier Children

Garner, Matthew R.; Bhat, Suneel B.; Khujanazarov, Ilkhom; Flynn, John M.; Spiegel, David A.

doi:10.1097/bpo.0b013e31820321ab

Cited by 50 publications

(26 citation statements)

References 23 publications

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“…There were 37 (62%) Type A fractures, 18 (30%) Type B, and 5 (8%) Type C. Fracture instability was defined as length unstable if it was complex or spiral (the length of the fracture was twice as long as the diameter of the femur at the level of the fracture) [11,40]. Forty (67%) were length-unstable fractures.…”

Section: Methodsmentioning

confidence: 99%

Submuscular Bridge Plating for Complex Pediatric Femur Fractures Is Reliable

Abdelgawad

Sieg

Laughlin

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Complex, high-energy pediatric femur diaphyseal fractures cannot be treated reliably by conventional methods: casting is not suitable for polytrauma and large children, external fixation is associated with a high rate of malalignment and refractures, elastic nails are unsuitable for unstable fractures and metaphyseal areas, and lateral trochanteric entry rigid nails cannot address proximal and distal fragments and need relatively large medullary canals.

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Section: Methodsmentioning

confidence: 99%

Submuscular Bridge Plating for Complex Pediatric Femur Fractures Is Reliable

Abdelgawad

Sieg

Laughlin

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…7-10 However, recent studies showed an increased risk of complications when flexible nails are used in heavier children and those with fractures of unstable length. [10][11][12][13] Femoral shaft fractures treated with rigid antegrade intramedullary nailing have shown promising results, but this treatment is generally reserved for older children and adolescents. [14][15][16] This technique affords stable internal fixation and allows for early mobilization.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Diaphyseal Femur Fractures: Submuscular Plating Compared With Intramedullary Nailing

Sutphen¹,

Mendoza²,

Mundy³

et al. 2016

Orthopedics

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This study compared the radiographic and clinical outcomes of pediatric diaphyseal femur fractures treated by submuscular plating, flexible retrograde intramedullary nailing, or rigid antegrade intramedullary nailing with a trochanteric entry point in skeletally immature patients who were 8 years and older. A retrospective review was conducted of skeletally immature patients 8 years and older who were treated for femur fracture with submuscular plating, flexible intramedullary nailing, or rigid intramedullary nailing from 2001 to 2014 with a minimum 12-week follow-up. Treatment outcomes were compared for statistical significance, including time to union, malunion, nonunion, heterotopic ossification, avascular necrosis, time to full weight bearing, limb length discrepancy, residual limp, painful hardware, and infection. The study identified 198 femur fractures in 196 patients (mean age, 11.9 years). Each femur fracture was treated with submuscular plating (35), flexible intramedullary nailing (61), or rigid intramedullary nailing (102). Mean follow-up across the cohort was 48 weeks, ranging from 12 to 225 weeks. Flexible nailing was associated with an increased incidence of malunion (P<.0001) and hardware irritation (P=.0204) and longer time to full weight bearing (P=.0018). Rigid nailing was associated with an increased incidence of limp at 12-week followup (P=.0412). Additionally, 23.5% of patients who were treated with rigid nailing had heterotopic ossification. Of all surgical methods, submuscular plating allowed for the most rapid return to full weight bearing (mean, 7 weeks) and offered the fastest healing rate (mean, 6 weeks). Submuscular plating resulted in faster times to union and full weight bearing, with minimal complication rates. Rigid intramedullary nailing with trochanteric entry resulted in a lower incidence of malunion and hardware-related complications; however, these patients had an increased incidence of heterotopic ossification and residual limp postoperatively. Flexible retrograde intramedullary nailing resulted in the highest rates of malunion and hardware irritation and the longest time to full weight bearing. [Orthopedics. 2016; 39(6):353-358.].

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“…Forty percent of patients treated with flexible nails (6/15) experienced complications. 23 Interestingly, the rate of complications in the matched group which underwent rigid locked nailing was not significantly different with 10 of 15 patients having a complication.…”

Section: Discussionmentioning

confidence: 90%