Interventions for treating femoral shaft fractures in children and adolescents

Abstract

Different methods of treating fractures of the shaft of the thigh bone in children and adolescents Although uncommon, fractures of the femoral shaft (thigh bone) in children may require prolonged treatment in hospital and sometimes surgery. This can cause significant discomfort and can disrupt the lives of the children and their familles. This review compared different methods of treating these fractures. Surgical treatment comprises different methods of fixing the broken bones, such as internally-placed nails, or pins incorporated into an external frame (external fixation). Non-surgical or conservative treatment usually involves different types of plaster casts with or without traction (where a pulling force is applied to the leg). We searched for studies in the medical literature until August 2013. The review includes 10 randomised or quasi-randomised controlled trials that recruited 527 children. Four trials compared different surgical versus non-surgical treatments; three compared different methods of non-surgical treatment and three compared different methods of surgical treatment. Generally we are unsure about the results of these trials because some were at risk of bias, some results were contradictory and usually there was too little evidence to rule out chance findings. Most trials failed to report on self-assessed function or when children resumed their usual activities. Comparing surgical versus non-surgical treatment. Low quality evidence (one trial, 101 children) showed children had similar function at two years after having surgery, involving external fixation, compared with those treated with a plaster cast. The other three trials did not report this outcome. There was moderate quality evidence (four trials, 264 children, aged 4 to 12 years, followed up for 3 to 24 months) that surgery reduced the risk of malunion (the leg is deformed) compared with non-surgical treatment. However, low quality evidence (four trials) indicated that there were more serious adverse events such as infections after surgery. There was low quality evidence (one trial, 101 children) of similar satisfaction levels in children and parents with surgery involving external fixation and plaster cast only. However, there was low quality evidence (one trial, 46 children) that more parents were satisfied with surgery involving an internal nail than with traction followed by a cast and that surgery reduced the time taken off from school. Comparing various non-surgical treatments. Very low quality evidence means that we are very unsure if the rates of malunion differ or not between children treated with immediate plaster casts versus with traction followed by plaster cast (one trial, 42 children), or between children treated with traction followed by either a functional orthosis (a brace or cast that allows some movement) or a cast (one trial, 43 children). We are very unsure if either function or serious adverse events differ between young children (aged two to seven years) immobilised in single-leg versus double-leg casts (one tria...

Current Concepts in Paediatric Femoral Shaft Fractures

“…The position of the knee (lesser than 90 0 flexion), lesser traction and cast padding are critical to avoid this complication. 1 According to a recent Cochrane review, the safe and effective position is 30 0 of abduction, 30 0 to 40 0 of flexion and external rotation at the hip [25]. The fracture location may also the dictate the amount of flexion needed at hip with more proximally located fractures needing more amount of flexion [20].…”

Treatment of closed femoral shaft fractures in children aged 2–10 years: a systematic review and meta-analysis

“…Both conservative options such as traction and spica casting and surgical options as elastic intramedullary nailing, plate fixation or a lateral femoral nail are used in daily practice. According to current consensus guidelines, treatment should differ according to age; younger children are advised to be treated with traction and/or spica cast while surgical intervention is preferred in older children [5,6]. Although the choice of treatment method in pediatric femur fractures in all age groups can be challenging, this is particularly difficult in children between 2 and 10 years of age: no consensus exists on whether conservative or surgical treatment is the best option for this particular age group.…”

De Novo Design, Synthesis and Evaluation of Benzylpiperazine Derivatives as Highly Selective Binders of Mcl‐1

“…This is a rare but disabling injury that can have significant effects on children. Madhuri et al examined trials that compared surgical and conservative interventions for diaphyseal fractures of the femur in children with a special emphasis on functional outcomes, unacceptable malunion and serious adverse events 4. Unfortunately, there was insufficient evidence to determine whether long‐term function was better or worse in the surgical or conservative groups.…”