Abstract
(1) Background: In adolescents, fractures of the femoral shaft that are not suitable for elastic-stable-intramedullary-nailing (ESIN), are challenging. We aimed to evaluate the health-related quality of life (HRQoL) and complications in adolescents treated with intramedullary rodding using the adolescent lateral trochanteric entry femoral nail (ALFN), and to assess if HRQoL was associated with additional injuries. (2) Methods: We followed-up on 15 adolescents with a diaphyseal femoral fracture who were treated with an ALFN from 2004 to 2017. Patients were asked to fill in a questionnaire that includes the iHOT, Peds-QL, and the Pedi-IKDC. (3) Results: The ALFN was used as a primary method of fixation in 13 patients, and as a fixation for failed ESIN in two cases. All 15 fractures healed radiographically. One distal locking screw broke. After a mean follow-up of 2.8 years, the mean iHOT-12 was 14.0 (SD 15.4), PedsQL-function was 85.7 (SD 19.3), PedsQL-social-score was 86.2 (SD 12.5), and the mean Pedi-IKDC was 77.2 (SD 11.3). In patients where the femoral fracture was an isolated injury, the HRQoL-scores were consistently higher compared with patients who sustained additional injures. (4) Conclusions: Treating diaphyseal fractures in adolescents with an ALFN resulted in good radiographic outcomes in all our cases. HRQoL, as measured by the iHOT, PedsQL, and Pedi-IKDC, was good to excellent; but it was consistently inferior in patients with additional injuries. These results suggest that the ALFN is a good alternative when patients are not suitable for ESIN, and that the HRQoL of adolescents who were treated with an ALFN is mainly influenced by the presence of additional injures, and less by the fracture of the femur itself.
Highlights
Since fractures of the femoral shaft are not too common among children (e.g., 0.89% [1]), many paediatricians and orthopaedic surgeons may have only limited experience in treating these injuries
Patients were asked to fill in a questionnaire that includes the iHOT, Peds-QL, and the Pedi-IKDC. (3) Results: The adolescent lateral trochanteric entry femoral nail (ALFN) was used as a primary method of fixation in 13 patients, and as a fixation for failed elastic intramedullary nailing (ESIN) in two cases
These results suggest that the ALFN is a good alternative when patients are not suitable for ESIN, and that the health-related quality of life (HRQoL) of adolescents who were treated with an ALFN is mainly influenced by the presence of additional injures, and less by the fracture of the femur itself
Summary
Since fractures of the femoral shaft are not too common among children (e.g., 0.89% [1]), many paediatricians and orthopaedic surgeons may have only limited experience in treating these injuries. Given the need for emergency surgery in children 3 years of age and older, every orthopaedic surgeon may be confronted with the need to perform surgery in these children. The preferred treatment strategy for paediatric femoral fractures is age dependent, ranging from bandage immobilization in new-borns to overhead extension or hip spica cast in children up to about 3 years of age. For older children up to the teenage years, elastic intramedullary nailing (ESIN) is the standard treatment. Treatment options in that age group include ESIN, external fixation [2], a combination of these two methods, submuscular plating [3], or rigid intramedullary rodding
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