Risk factors for refracture of the femoral shaft in children after removal of external fixation

Meizhen Guo,Yuxi Su

doi:10.1186/s10195-021-00569-9

Abstract

BackgroundExternal fixation is the primary treatment option in children for femoral shaft fractures, such as open femoral or multiple fractures. One complication is refracture, which is the biggest limitation of fixation devices. This study aims to investigate the risk factors associated with refracture after the removal of external fixation devices and decrease the frequency of refracture.Materials and methodsRetrospectively reviewed clinical data of 165 patients treated at our hospital for fresh femoral shaft fractures with external fixation between May 2009 and February 2018 were included in this study. Patients with pathological fractures, fractures of the femoral neck, fractures that were fixed using plates or elastic stable intramedullary nailing, and old fractures, as well as those who underwent postoperative femoral surgery were excluded. Potential risk factors included: patient age, gender, and weight, fracture sides, open or closed fracture, fracture sites, reduction methods, operation time, perioperative bleeding, number and diameter of the screws, and immobilization time. These factors were identified by univariate and logistic regression analyses.ResultsFemoral shaft refracture developed in 24 patients. Univariate analysis revealed that refracture was not statistically significantly associated with any of the above factors, except AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF) classification type 32-D/4.2 and L2/L3 ratio (L2, length of femur fixed by the two screws farthest from the fracture line; L3, the total length from the greater trochanter to the distal end of femur; P < 0.001 and P = 0.0141, respectively). Multivariate analysis showed that PCCF classification type 32-D/4.2 and L2/L3 ratio were also independent risk factors for femoral refracture.ConclusionsFemoral shaft refracture is relatively common in children treated with external fixation. Because of the limited number of cases in this study, we cautiously concluded that the PCCF classification type 32-D/4.2 and L2/L3 ratio were independent risk factors for femoral shaft refracture in these patients.Level of evidenceIV

Highlights

Femoral shaft fracture is not rare, accounting for about 1.6–2% of all trauma accidents in children [1, 2]
Univariate analysis revealed that refracture was not statistically significantly associated with any of the above factors, except AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF) classification type 32-D/4.2 and L2/L3 ratio (L2, length of femur fixed by the two screws farthest from the fracture line; L3, the total length from the greater trochanter to the distal end of femur; P < 0.001 and P = 0.0141, respectively)
Multivariate analysis showed that PCCF classification type 32-D/4.2 and L2/L3 ratio were independent risk factors for femoral refracture

Summary

Introduction

Femoral shaft fracture is not rare, accounting for about 1.6–2% of all trauma accidents in children [1, 2]. The treatment of simple pediatric femoral shaft fractures is based on the patient’s age [3]. The American Academy of Orthopedic Surgeons and the Pediatric Orthopedic Society of North America [4, 5] suggest that treatment for femoral shaft fractures in children under the. For school-aged children or even younger patients, elastic intramedullary nail (EIN) fixation is the first choice and becoming increasingly accepted by most surgeons [6–8]. External fixation (EF) may still be used when EIN is not a suitable option, such as with open fixation, multiple fractures, femoral fractures with severe skins lesions, patient weight over 50 kg, proximal or distal humeral fractures that EIN fixation cannot fix [9, 10]. External fixation is the primary treatment option in children for femoral shaft fractures, such as open femoral or multiple fractures. This study aims to investigate the risk factors associated with refracture after the removal of external fixation devices and decrease the frequency of refracture

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Discussion

Conclusion