Abstract
BackgroundLocking plate (LP) is a good choice in the treatment of length-unstable femoral shaft fracture in children. Monolateral external fixator (EF) has been reported for this condition for decades. This study aims to compare the clinical outcomes of school-aged children with length-unstable femoral shaft fracture treated with LP vs. EF.MethodsPatients aged 5–11 years old with length-unstable femoral shaft fractures treated at our institute from January 2014 to January 2018 were retrospectively reviewed and categorized into LP and EF groups. The preoperative data, including baseline information of the patients, radiographic parameters, and types of surgical procedure, were collected from the hospital database, and postoperative data, including complications, were collected during the follow-up visits.ResultsOverall, 36 patients (average, 8.2 ± 2.1 years; male, 20; female, 16) in the LP group and 35 patients (average, 8.3 ± 2.3 years; male 20, female 15) in the EF group were included. There was significantly less operative time for EF (45.4 ± 7.8 min) compared with LP (67.8 ± 11.3 min) (P < 0.001). As for the frequency of fluoroscopy, there was a significant difference between the EF (13.9 ± 2.4) and LP (16.5 ± 3.2) groups (p < 0.001). The rate of major complications was not significantly different between these two groups. There was a significant difference between the EF group (11.2 ± 5.8 mm) and the LP group (7.5 ± 1.6 mm) group concerning limb length discrepancy (P < 0.001).ConclusionBoth LP and EF produce satisfactory outcomes in school-aged children with length unstable femoral shaft fractures. External fixation remains a viable choice without the necessity of secondary surgery for hardware removal.
Highlights
Locking plate (LP) is a good choice in the treatment of length-unstable femoral shaft fracture in children
Traction followed by spica casting, elastic stable intramedullary nail (ESIN), plating, external fixator (EF), and antegrade rigid intramedullary nailing have been reported for the treatment of femoral fracture in children and adolescents [3,4,5,6,7]
EF has been a valuable option for pediatric femoral shaft fractures for decades, but the complications, including superficial infection, difficulty of daily care, and possibility of refracture, lead to the waning enthusiasm of its application in recent years [11, 12]
Summary
Locking plate (LP) is a good choice in the treatment of length-unstable femoral shaft fracture in children. This study aims to compare the clinical outcomes of school-aged children with length-unstable femoral shaft fracture treated with LP vs EF. For children with length-unstable fracture, plating proved to be superior to ESIN in clinical outcomes [8, 9], but the plate requires removal afterwards, a process with reported complications of hemorrhage and infection. EF has been a valuable option for pediatric femoral shaft fractures for decades, but the complications, including superficial infection, difficulty of daily care, and possibility of refracture, lead to the waning enthusiasm of its application in recent years [11, 12].
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