Intramedullary Nailing Compared with Spica Casts for Isolated Femoral Fractures in Four and Five-Year-Old Children

Ramo, Brandon; Martus, Jeffrey E.; Tareen, Naureen; Hooe, Benjamin S.; Snoddy, Mark C.; Jo, Chan Hee

doi:10.2106/jbjs.o.00706

Cited by 41 publications

(47 citation statements)

References 23 publications

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“…We found minor differences in the mean coronal and sagittal angulations between the ESIN and SPICA groups, consistent with the findings of Saseendar et al [10], Heffernan et al [24], and Ramo et al [26]. Two patients in the SPICA group showed unacceptable alignment at the time of union, one of whom was a 4-year-old boy with 20° varus and 30° anterior angulation, and another was a 4.5-year-old boy with 30° varus and 25° anterior angulation; both patients also showed limb length discrepancy at the time of union (2-and 2.5-cm shortening, respectively).…”

Section: Discussionsupporting

confidence: 91%

Diaphyseal Femoral Fractures in Children: Comparison Between Elastic Stable Intramedullary Nailing and Conservative Management

Hwaizi¹,

Saeed²,

Mahmood³

2018

TOORTHJ

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Background:Femoral shaft fractures are one of the most common fractures of the lower extremities in children. Although many approaches and options are available for their treatment, the most appropriate treatment option for school going children is still debatable.Objective:This study investigated the efficacy, safety, and outcome of surgical intervention with Elastic Stable Intramedullary Nailing (ESIN) in 3–12-year-old children with diaphyseal femoral fractures and compared them with those of conservative management.Methods:In this prospective study, 41 children with diaphyseal femoral fractures were recruited between April 2013 and April 2016. The fractures were divided into two equal groups: one treated with ESIN, and the other with early spica casting or noninvasive traction followed by hip spica casting. Demographic data, clinical information, and serial radiographic findings were collected and compared between the two groups. Flynn’s scoring criteria pertaining to time to union, assisted weight bearing, independent ambulation, return to school, and complications were applied. Fischer’s exact test was used for statistical analyses.Results:Compared with spica casting-treated fractures, ESIN-treated fractures healed faster with lower average time to assisted weight bearing, independent ambulation, and return to school. Hip spica-treated children had a higher rate of major complications than ESIN-treated children. At 1-year follow-up, higher limb length discrepancy was reported in hip spica-treated children than in ESIN-treated children (P< 0.001).Conclusion:ESIN is a safe and effective approach for treating femoral shaft fractures in children; it provides better functional and radiographic outcomes than spica casting and can be used in preschool-age children.

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Section: Discussionsupporting

confidence: 91%

Diaphyseal Femoral Fractures in Children: Comparison Between Elastic Stable Intramedullary Nailing and Conservative Management

Hwaizi¹,

Saeed²,

Mahmood³

2018

TOORTHJ

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“…The first step of our study was the evaluation of our patient population in regard to comparability with cohorts investigated in the recent literature. Like others, we found boys to be predominantly affected by isolated femoral fractures, and simple falls were the most common cause [3,17,24]. Child abuse was only suspected in 4.8 % of cases in the present study; this finding was in contrast to that of Rewers et al, who reported suspected child abuse as the reason of femoral fracture in 14.8 % of all cases [26].…”

Section: Discussioncontrasting

confidence: 78%

Overhead-Extension für die Therapie der isolierten Femurfraktur des Kleinkindes – Was lernt man von den Eltern

2019

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Zusammenfassung Hintergrund Die konservative Therapie ist der Standard bei Unter-4-jährigen mit Femurfraktur. Um die Zufriedenheit der Eltern mit dieser aufwändigen Behandlung zu verbessern haben wir wichtige Einflussfaktoren auf diesen wichtigen Behandlungsaspekt untersucht. Patienten: 42 Fälle von Kindern unter 4 Jahren, mit Femurfraktur und Overheadextension-Therapie (OHE) wurden analysiert. Methode Unser Standardverfahren beinhaltet die 10-tägige OHE mit anschließender Becken-Bein-Gips-Behandlung (BBG). Röntgenbilder wurden bezgl. des Heilverlaufs analysiert. Die Eltern wurden mittels eines pseudonymisierten Fragebogens über ihre Erfahrungen befragt. Ergebnisse Die Art der Fraktur wurde 73.3% der Eltern „verständlich und detailliert“ erklärt. 23.3% gaben an, dass „viele Fragen unbeantwortet” blieben. 70% der Eltern bemerkten Verhaltensauffälligkeiten bei Ihrem Kind, 63.3% berichteten von therapie-spezifischen Problemen. 86.7% der Eltern waren mit dem Behandlungserfolg zufrieden, 80% mit der Art der Therapie und 73.3% würden die OHE erneut wählen. Spearman-Korrelations-Analysen fanden eine signifikante Korrelation zwischen der generellen Elternzufriedenheit und einem hohen Grad an Aufklärung bzgl. der Art der Fraktur. Eltern, welche Probleme während der Visite ansprechen konnten zeigten eine signifikant höhere Zufriedenheit. Diskussion Die meisten Gründe für eine Unzufriedenheit der Eltern waren in Verbindung mit Kommunikationsproblemen zu sehen. Schlussfolgerung Eine gute Evaluierung während der Visite, gute Kommunikation mit den Ärzten sowie gute pflegerische Hilfestellung beeinflussen die Zufriedenheit der Familien erheblich.

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“…ESIN resulted in better fracture length and alignment, as well as earlier weight-bearing and return to nursery. 6 Finally, Ramo et al 11 reported similar rates of unplanned revision surgery in their cohort of 262 patients, with 4% in both groups returning to the operating room. Although these studies are important additions to the literature on this topic, they may be underpowered to detect statistically notable differences in the revision surgery rate.…”

Section: Discussionmentioning

confidence: 85%

“…Potential advantages of ESIN are quicker mobilization and return to activities, more stable fixation with possibly less malunion and greater ease of care. 6 , 8 , 10 , 11 Disadvantages are that it is a more invasive surgical procedure that may require a second operation for implant removal and that the estimated immediate costs are higher compared with spica. 9 , 12 , 13 Spica casting is less invasive and has a lower estimated immediate cost.…”

Section: Discussionmentioning

confidence: 99%

Spica Casting Results in More Unplanned Reoperations than Elastic Intramedullary Nailing: A National Analysis of Femur Fractures in the Preschool Population

Brnjoš

Lyons²,

Hyman³

et al. 2020

JAAOS Glob Res Rev

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Background: Spica casting and elastic stable intramedullary nailing (ESIN) are treatment options for femur fractures in preschool-age children. Clinical practice guidelines are only of moderate or limited strength, which may lead to variation in practice. The purpose of this study was to compare the revision surgery rate in young children undergoing these procedures. Methods: The Pediatric Health Information System, a database of 49 children hospitals, was queried for patients aged 3 to 6 years undergoing spica casting or ESIN for a diaphyseal femur fracture. ESIN removal was not considered an unplanned revision surgery because the indication for removal could not be determined in the database. Univariate analysis was followed by multivariate regression. Results: Analysis included 4,059 subjects with a mean age of 3.9 ± 1.1 years. Unplanned revision surgery was done in 227/2,878 children (8%) with a spica cast and 35/1,181 (3%) of those with ESIN ( P < 0.01). Approximately 2% of children in each cohort underwent ESIN or open reduction and internal fixation as a revision procedure ( P = 0.35). In multivariate analysis, spica casting resulted in 4.4 times higher odds of unplanned revision surgery than ESIN (95% confidence interval [CI], 2.9–6.7; P < 0.01). In the spica cast cohort, each year of increasing age resulted in 1.3 times higher odds of revision surgery (95% CI, 1.1–1.6; P < 0.01). Children who were aged 5 or 6 years at the time of spica casting had 1.9 times higher odds of requiring a subsequent procedure compared with 3- and 4-year-olds (95% CI, 1.3–2.7; P < 0.01). Conclusions: In this large, nationally representative cohort, spica casting resulted in higher odds of requiring an unplanned revision surgery than ESIN, when nail removal was not included as an unplanned procedure. Spica casting in 5- and 6-year-olds yielded higher odds of revision surgery. Regardless of whether spica casting or ESIN is chosen as the initial treatment, 2% of patients will subsequently undergo ESIN or open reduction and internal fixation as a revision procedure.

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Intramedullary Nailing Compared with Spica Casts for Isolated Femoral Fractures in Four and Five-Year-Old Children

Abstract: Preschool-age children (four to five years old) with an isolated femoral fracture have similar clinical and radiographic outcomes regardless of whether they are treated with immediate spica cast immobilization or IMN.

Cited by 41 publications

References 23 publications

Diaphyseal Femoral Fractures in Children: Comparison Between Elastic Stable Intramedullary Nailing and Conservative Management

Diaphyseal Femoral Fractures in Children: Comparison Between Elastic Stable Intramedullary Nailing and Conservative Management

Overhead-Extension für die Therapie der isolierten Femurfraktur des Kleinkindes – Was lernt man von den Eltern

Spica Casting Results in More Unplanned Reoperations than Elastic Intramedullary Nailing: A National Analysis of Femur Fractures in the Preschool Population

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