Treatment of Femoral Fractures in Children by Pediatric Orthopedists: Results of a 1998 Survey

Sanders, James O.; Browne, Richard; Mooney, James F.; Raney, Ellen M.; Horn, B. David; Anderson, David J.; Hennrikus, William L.; Robertson, W. W.

doi:10.1097/01241398-200107000-00004

Cited by 92 publications

(69 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Over the last 20 years, FIN has proven more effective than SCI, avoiding the burden of the cast while significantly shortening the duration of immobilisation and the time to full weight bearing [1]. The lower age limit for FIN has yet to be defined and most publications now refer to the onset of the school-aged period (5-6 years old) as the lower limit [10]. The AAOS 1 Clinical Practice Guideline for the treatment of paediatric diaphyseal femur fracture suggests early SCI or traction with delayed SCI in children aged 6 months to 5 years [11].…”

Section: Discussionmentioning

confidence: 99%

Immediate hip spica is as effective as, but more efficient than, flexible intramedullary nailing for femoral shaft fractures in pre-school children

Jauquier¹,

Doerfler

Haecker

et al. 2010

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

Flexible intramedullary nailing (FIN) is the gold standard treatment for femur fracture in school-aged children. It has been performed successfully in younger children, although Spica cast immobilisation (SCI) has been the most widely used strategy to date. Method A retrospective analysis was performed between two comparable groups of children aged 1-4 years with a femoral shaft fracture. Two University hospitals, each using specific treatment guidelines, participated in the study: SCI in Group I (Basel, Switzerland) and FIN in Group II (Lausanne, Switzerland). Results Group I included 19 children with a median age of 26 months (range 12-46 months). Median hospital stay was 1 day (range 0-5 days) and casts were retained for a median duration of 21 days (range 12-29 days). General anaesthesia was used in six children and sedation in four. Skin breakdown secondary to cast irritation occurred in two children (10.5%). The median follow-up was 114 months (range 37-171 months). No significant malunion was noted. Group II included 27 children with a median age of 38.4 months (range 18.7-46.7 months). Median hospital stay was 4 days (range 1-13 days). All children required general anaesthesia for insertion and removal of the nails.Free mobilisation and full weight bearing were allowed at a median of 2 days (range 1-10 days) and 7 days (range 1-30 days), respectively, postoperatively. Nail exteriorisation was noted in three children (11%). The median followup was 16.5 months (range 8-172 months). No significant malunion was reported. Conclusions Young children with a femoral shaft fracture treated by SCI or FIN had similarly favourable outcomes and complication rates. FIN allowed earlier mobilisation and full weight bearing. Compared to SCI, a greater number of children required general anaesthesia. In a pre-school child with a femoral shaft fracture, immediate SCI applied by a paediatric orthopaedic team following specific guidelines allowed early discharge from hospital with few complications.

show abstract

Section: Discussionmentioning

confidence: 99%

Immediate hip spica is as effective as, but more efficient than, flexible intramedullary nailing for femoral shaft fractures in pre-school children

Jauquier¹,

Doerfler

Haecker

et al. 2010

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

show abstract

“…During the past 20 years, titanium elastic nailing (TEn) has become the most widely used treatment for diaphyseal femoral fractures in school-aged children over 6 years of age (4)(5)(6). The advantages of TEn include its minimal invasiveness and the ability for direct mobilization to maintain joint movement and muscle tone as well as normal circulation (7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Pitfalls of femoral Titanium Elastic Nailing

et al. 2014

View full text Add to dashboard Cite

Background and Aims: Despite several potential complications of elastic intramedullary nailing, it is currently the treatment of choice for femoral diaphyseal fractures in schoolaged children. this study aimed to critically evaluate the complications of titanium elastic nailing in pediatric femoral shaft fractures.Material and Methods: this study evaluated patients with a diaphyseal femoral fracture treated with titanium elastic nailing (ten) in tampere university Hospital in finland. the study group included 32 children with a mean age of 9 years during a 5-year period, from 1 January 2003 to 31 December 2007. Data were collected from medical records and x-rays. mean follow-up time was 42 months.Results: of 32 patients, 9 (28%) reported a postoperative complication. complications were associated with nail prominence in five (16%) patients and instability in four (12%) patients. in patients with nail prominence, the titanium elastic nailing-nail ends were unbent and 10-35 mm outside the cortex of the distal femur. the nail prominence caused pain and delayed knee mobilization until the nail was removed after a mean time of 4 months. in patients with fracture instability, the mean titanium elastic nailing-nail/ medullary canal diameter ratio was 46% and periosteal callus formation was 5.4 mm at the first control. in those with stable fractures, the values were 66% and 9.2 mm, respectively.Conclusions: based on this study, two types of pitfalls in a small volume center were found. titanium elastic nail ends were left unbent and too long. We recommend palpating the nail ends to exclude nail prominence and to verify free movement of the knee after nail cutting and bending. fracture instability was caused by inserting titanium elastic

show abstract

“…It functions as an internal splint that holds length and alignment but permits enough motion at the fracture site to generate sufficient callus [11] . This fixation technique is good to fix mid shaft transverse femoral fractures [33] . Fixation of proximal or distal end or comminuted fracture type with elastic intramedullary nailing will need further supplementation, either with a cast or a brace.…”

Section: Discussionmentioning

confidence: 99%

“…Flexible intramedullary nailing has increased in popularity in the United States in the 1990s [11,32] and is now the most commonly used treatment method for fractures of the femur in schoolaged children [33,34] . Flexible nailing helps to achieve biological and minimally invasive fixation and allows rapid mobilization with an overall low risk of physeal injury, femoral head AVN, or refracture [34,35] .…”

Section: Discussionmentioning

confidence: 99%