Submuscular plates <i>versus</i> flexible nails in preadolescent diaphyseal femur fractures

Chen, L. K.; Sullivan, Brian; Sponseller, Paul D.

doi:10.1302/1863-2548.12.180036

Cited by 20 publications

(24 citation statements)

References 30 publications

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“…As plate fixation in general is not considered a treatment modality for this age group, we decided not to include this in our study either. Nevertheless, several studies found that IMN has better outcomes than plate fixation at young age [45][46][47][48][49][50].…”

Section: Results and Previous Literaturementioning

confidence: 99%

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

Cruchten

Warmerdam²,

Kempink

et al. 2021

Eur J Trauma Emerg Surg

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Objective To review current literature on treatment of closed femoral shaft fractures in children of 2–10 years old, with subgroup analysis of children aged 2–6 years, comparing intramedullary nailing (IMN) to conservative treatment modalities. Methods We included clinical trials and observational studies that compared traction and subsequent casting (TSC), spica casting and IMN for treatment of femur shaft fractures in children of 2–10 years of age. Subgroup analysis of children aged 2–6 years was performed. Results Compared to treatment with immediate spica casting, IMN led to significantly less coronal angulation (mean difference (MD): 2.03 degrees, confidence interval (CI) 1.15–2.90), less sagittal angulation (MD: 1.59 degrees, CI 0.82–2.35) and lower rates of LLD (Risk difference (RD): 0.07, CI 0.03–0.11). In terms of rehabilitation, IMN leaded to shorter time until walking with aids (MD: 31.53 days, CI 16.02–47.03), shorter time until independent ambulation (MD: 26.59 days, CI 22.07, 31.11) and shorter time until full weight bearing (MD: 27.05 days, CI 6.11, 47,99). Compared to TSC, IMN led to a lower rate of malunion (RD: 0.31, CI 0.05–0.56), shorter hospital stays (MD: 12.48 days, CI 11.57, 13.39), time until walking with aids (MD: 54.55, CI 40.05–69.04) and full weight bearing (MD: 27.05 days [6.11, 47,99]). Conclusion Although a lack of quality evidence, this systematic review showed a clear tendency to treatment with elastic intramedullary nails of femoral shaft fractures in children of 2–10 years of age. Level of evidence 3.

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Section: Results and Previous Literaturementioning

confidence: 99%

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

Cruchten

Warmerdam²,

Kempink

et al. 2021

Eur J Trauma Emerg Surg

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“…Enhanced biomechanical stability while simultaneously preserving fracture biology, especially in heavier children as well as in length unstable femur fractures has been highlighted as advantages of SMP over ESIN [11,[33][34][35]. However, bigger surgical exposure, larger volume of blood loss, longer hospital stay and difficulty encountered in implant removal are possible disadvantages [36].…”

Section: Discussionmentioning

confidence: 99%

Elastic stable intramedullary nailing versus submuscular plating in pediatric diaphyseal femur fractures: a randomized controlled trial among children in South India

James

Dennis²,

Kumar

et al. 2021

Journal of Pediatric Orthopaedics B

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Elastic stable intramedullary nailing (ESIN) is the current preferred method for treating diaphyseal femur fractures in children. Introduction of the submuscular locked plate (SMP) fixation construct has opened the debate on treatment options for pediatric diaphyseal femur fractures in the older children and adolescents. A randomized controlled trial (RCT) protocol was designed to compare ESIN and SMP for diaphyseal femur fractures in children. An open-labelled RCT comparing SMP with ESIN was conducted from January 2013 to June 2016, for children aged 6-15 years with closed, acute femoral diaphyseal fractures. Randomization was done through computergenerated randomization sequence and opaque-sealed envelopes. Rate of adverse surgical events including unplanned re-operations was assessed as the primary outcome and secondary analysis was done for time to union, degree of malunion, limb length discrepancy, functional outcome at 2 years, surgical duration and blood loss, radiation exposure, hospital stay, cost incurred and secondary implant removal procedure. Forty children were randomized with allocation concealment. There were three adverse events in the SMP arm and five in the ESIN arm. Fifteen children with SMP underwent routine implant removal compared to only three children with ESIN (P < 0.001). Both ESIN and SMP are equally safe, viable and effective options for treating pediatric diaphyseal femoral fractures. However, the additional cost of secondary surgery for implant removal in the SMP group proved to be a deterrent factor, which led to ESIN being the preferred option in our resource-limited setting. J

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“…15 Chen et al found that the use of FIN was associated with a shorter operative time, less blood loss and shorter length of hospitalisation compared to submuscular plating. 16 Concerns with antegrade nailing are that the blood supply to the femoral head may be compromised and that penetration through the greater trochanteric epiphysis may lead to epiphysiodesis and proximal femoral growth deformities. It is for these reasons that a retrograde approach, or antegrade approach with an entry port distal to the greater trochanteric epiphysis has been popularised with FIN insertion.…”

Section: Discussionmentioning

confidence: 99%

Antegrade flexible intramedullary nailing through the greater trochanter in paediatric femur shaft fractures

et al. 2019

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Aims: To determine whether an antegrade approach, through the tip of the greater trochanter, in femoral shaft fractures in children, is safe, achieves adequate union and results in significant proximal femoral growth complications. Patients and methods: The case records and radiographs of 23 paediatric patients aged 7 to 12 years with femur shaft fractures managed with stainless steel antegrade flexible nailing were reviewed retrospectively. Pre-operative radiographs were reviewed for fracture pattern, level and comminution. Post-operative radiographs were reviewed to assess for union, alignment, osteonecrosis of the femoral head and epiphysiodesis of the greater trochanter. Morphological changes of the proximal femur were assessed by comparing the neck shaft angle and articulo-trochanteric distance with the opposite hip. Case records were reviewed for post-operative complications, patient-reported complaints and leg length discrepancy. Clinical outcomes were assessed with the criteria established by Flynn. Results: All patients achieved union, and none had evidence of osteonecrosis of the femoral head on follow-up. Three patients had malalignment and two patients had radiographic evidence of greater trochanteric epiphysiodesis. Two patients had morphological changes of the proximal femur, with one having an increased neck shaft angle and one an increased articulo-trochanteric distance. One patient had a leg length discrepancy of 2 cm. Fifteen patients had excellent clinical outcomes, five had satisfactory outcomes and three had poor outcomes according the criteria established by Flynn. Conclusion: Antegrade entry through the tip of the greater trochanter does not appear to compromise the blood supply to the femoral head or increase the risk of clinically significant morphological changes to the proximal femur. All patients achieved adequate union. Furthermore, antegrade insertion avoided skin problems and prominent nail complications around the knee seen with retrograde insertion.

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Submuscular plates versus flexible nails in preadolescent diaphyseal femur fractures

Cited by 20 publications

References 30 publications

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

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

Elastic stable intramedullary nailing versus submuscular plating in pediatric diaphyseal femur fractures: a randomized controlled trial among children in South India

Antegrade flexible intramedullary nailing through the greater trochanter in paediatric femur shaft fractures

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