Remodelling and overgrowth after conservative treatment for femoral and tibial shaft fractures in children

Stilli, Stefano; Magnani, Marina; Lampasi, Manuele; Antonioli, Diego; Bettuzzi, Camilla; Donzelli, Onofrio

doi:10.1007/s12306-007-0003-6

Cited by 35 publications

(24 citation statements)

References 26 publications

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“… 5 , 23 , 25 - 27 However, time to union in surgically treated tibial shaft fractures is longer than in fractures treated non-operatively since time to union varied from 13 weeks to 18 weeks for the latter. 3 , 28 …”

Section: Discussionmentioning

confidence: 99%

Paediatric tibial shaft fractures treated by open reduction and stabilization with monolateral external fixation

Simon

Apostolou

Vidal

et al. 2018

Journal of Children's Orthopaedics

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PurposeElastic stable intramedullary nailing is increasingly used for surgical treatment of tibial shaft fractures, but frequently requires immobilization and delayed full weight-bearing. Therefore, external fixation remains interesting. The aim was to report clinico-radiological outcomes of monolateral external fixation for displaced and unstable tibial shaft fractures in children.MethodsAll tibial fractures consecutively treated by monolateral external fixation between 2008 and 2013 were followed. Inclusion criteria included skeletal immaturity and closed and open Gustilo I fractures caused by a direct impact. Patients were seen until two years postoperatively. Demographics, mechanism of injury, surgical data and complications were recorded. Anteroposterior and lateral side radiographs were performed at each visit. Full-limb 3D reconstructions using biplanar stereroradiography was performed for final limb length and alignment measures.ResultsA total of 45 patients (mean age 9.7 years ± 0.5) were included. In all, 17 were Gustilo I fractures, with no difference between open and closed fractures for any data. Mean time to full weight bearing was 18.2 days ± 0.7. After 15 days, 39 patients returned to school. Hardware removal (mean time to union 15.6 weeks ± 0.8) was performed during consultation under analgesic gas. There were no cases of nonunion. No fracture healed with > 10° of angulation (mean 5.1° ± 0.4°). Leg-length discrepancy > 10 mm was found for six patients.ConclusionsThis procedure can be a safe and simple surgical treatment for children with tibial shaft fractures. Few complications and early return to school were reported, with the limitations of non-comparative study.Level of EvidenceIV

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Section: Discussionmentioning

confidence: 99%

Paediatric tibial shaft fractures treated by open reduction and stabilization with monolateral external fixation

Simon

Apostolou

Vidal

et al. 2018

Journal of Children's Orthopaedics

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“…According to a number of studies that investigated the biomechanical effects of LLD, back pain, hip pain, and stress fractures have been reported as musculoskeletal disorders associated with LLD [14][15][16]. Most of the overgrowth has been shown to occur within 18 months after the fracture, and the average overgrowth at the time of follow-up was approximately 6 mm in cases of tibial shaft fractures [17]. This is thought to be due to the physiological processes associated with posttraumatic activation of the growth plate [18,19].…”

Section: Open Accessmentioning

confidence: 99%

Leg length discrepancy, overgrowth, and associated risk factors after a pediatric tibial shaft fracture

et al. 2021

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Background This study was performed to investigate leg length discrepancy (LLD), overgrowth, and associated risk factors after pediatric tibial shaft fractures. Materials and methods This study included 103 patients younger than 14 years of age (mean age 7.1 years; 75 boys, 28 girls) with unilateral tibial shaft fracture and a minimum follow-up of 24 months. LLD was calculated as the difference between the lengths of the injured and uninjured limbs. Overgrowth was calculated by adding the fracture site shortening from the LLD. Risk factors were assessed in patients with LLD < 1 cm and ≥ 1 cm and overgrowth < 1 cm and ≥ 1 cm. Results Casting and titanium elastic nailing (TEN) were performed on 64 and 39 patients, respectively. The mean LLD and overgrowth were 5.6 and 6.4 mm, respectively. There were significant differences in sex (p = 0.018), age (p = 0.041), fibular involvement (p = 0.005), injury mechanism (p = 0.006), and treatment methods (p < 0.001) between patients with LLDs < 1 cm and ≥ 1 cm. There were significant differences in sex (p = 0.029), fibular involvement (p = 0.002), injury mechanism (p = 0.008), and treatment methods (p < 0.001) between patients with overgrowth < 1 cm and ≥ 1 cm. Sex and treatment methods were risk factors associated with LLD ≥ 1 cm and overgrowth ≥ 1 cm following pediatric tibial shaft fracture. The boys had a 7.4-fold higher risk of LLD ≥ 1 cm and 5.4-fold higher risk of overgrowth ≥ 1 cm than the girls. Patients who underwent TEN had a 4.3-fold higher risk of LLD ≥ 1 cm and 4.8-fold higher risk of overgrowth ≥ 1 cm than those treated by casting. Conclusions Patients undergoing TEN showed greater LLD and overgrowth than those undergoing casting, with boys showing greater LLD and overgrowth than girls. Surgeons should consider the possibility of LLD and overgrowth after pediatric tibial shaft fractures, especially when performing TEN for boys. Level of evidence Level III

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“…The distance of the deformity to the physis and the width of the physis are important factors in terms of remodeling. Closeness to the physis and a wide physis have a positive effect on remodeling [8]. Differences in limb length and angulation, which are among the problems encountered after treatment of femoral diaphysis fractures, are widely found in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…Among non-surgical treatment methods of childhood femoral diaphysis fractures are early plastering after closed reduction and late plastering following traction. Surgical treatment is considered for severely segmented fractures, cases with vascular nerve injuries, cases with head trauma and accompanying injuries, and cases with multiple injuries and open wounds requiring care [7][8][9]. In our study, we aimed to evaluate the healing -remodeling capacities of femoral diaphysis fractures treated with nonsurgical methods in preschool children.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2017

J Ann Eu Med

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Amaç: Çalışmamız konservatif tedavi edilen okul çağı cocukları femur diafiz kırığı iyileşme ve yeniden şekillenme kapasitesini değerlendirmeyi amaçlamıştır. Gereç ve Yöntem: 0-6 yaş arası konservatif tedavi edilen 36 kapalı femur diafiz kırığı olan hasta çalışmaya dahil edildi. Alçılama sonrası iki yönlü grafileri alındı. Hastaların bacak uzunlukları kaydedildi. Hastalar takip süresine gore iki gruba ayrıldı: 0-60 ay (Grup A) ve 60 üzeri (Grup B). Tedavi sonrası ve son kontrolde tekrar radyografiler ve uzunluk ölçümü alınarak veriler değerlendirildi. Bulgular: Hastaların ortalama yaşı 4.2±1.94 yıl idi. Alçı çıkarıldıktan sonraki ve son kontroldeki kısalık ölçümü ortalama değerleri sırası ile 1.61±0.84 cm ve 0.8±0.74 cm idi. Koronal ve sagital plandaki angulasyon miktarları istatistiksel olarak anlamlı idi (p<0.01). Kısalık miktarlarında azalma istatistiksel olarak anlamlı idi (p<0.01). Grup B'deki hastaların angulasyon miktarı Grup A'dan istatistiksel olarak anlamlı derecede yüksek idi (p<0.05). A ve B Grupları arasındaki sagital plandaki düzelme miktarları arasında istatistiksel olarak anlamlı değişim görülmedi (p>0.05). Tartışma: Çalışmamızda koronal plan deformitelerinin 5 yıldan sonra da istatistiki olarak anlamlı miktarda yeniden şekillenmeye devam ettiğini tespit ettik.

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Remodelling and overgrowth after conservative treatment for femoral and tibial shaft fractures in children

Cited by 35 publications

References 26 publications

Paediatric tibial shaft fractures treated by open reduction and stabilization with monolateral external fixation

Paediatric tibial shaft fractures treated by open reduction and stabilization with monolateral external fixation

Leg length discrepancy, overgrowth, and associated risk factors after a pediatric tibial shaft fracture

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