Abstract
ABSTRACT BACKGROUND: Femoral diaphyseal fracture is a common paediatric orthopaedic injury; however, the management of these fractures remains controversial in children between the ages of 6 and 13 years. The preferred approach for children appears to be surgical, enabling early mobilisation. Some studies have reported that submuscular bridge plating (SBP) might be a good alternative treatment method with favourable outcomes. The aim of this study was to determine whether SBP a) leads to union in length-unstable fractures with a low complication rate; b) leads to reasonable alignment and leg length equality; and c) has acceptable clinical outcomes in a South African tertiary hospital setting. METHODS: All patients with predominantly length-unstable femoral diaphyseal fractures who were treated between 1 January 2011 and 31 December 2012 were included in this study. Patients were treated with SBP using standard of care techniques, and hardware removal was performed at approximately eight months post-operatively. The nine months post-operative assessment between the affected and unaffected leg was used to assess the effectiveness of the SBP intervention RESULTS: A total of 29 patients (mean age 9±2 years) were included. The majority of the fractures (n=27, 93%) were length-unstable. Two patients (7%) had transverse fractures with >2 cm overlap and/or weighing >45 kg. All fractures healed within expected time frames. No overall leg length discrepancy (p=0.94) or coronal mechanical axis deviation (p=0.51) was observed between the affected and unaffected lower limbs at nine months post-surgery. No differences between the operated and non-operated sides were observed for hip flexion (p=0.88), hip external rotation (p=0.36), hip internal rotation (p=0.12) or knee flexion (p=0.96 CONCLUSION: SBP provides reliable outcomes in children with diaphyseal femoral fractures and is our preferred method of fixation for a) length-unstable fractures; b) fractures close to the metaphysis; and c) children weighing more than 45 kg Level of evidence: Level 4 Keywords: femoral fractures, paediatric, orthopaedic surgery, children
Highlights
Femoral shaft fractures are among the most common major paediatric orthopaedic injuries,[1] accounting for between 1.4 and 1.7% of all fractures seen in the paediatric population.[2]
The aim of the study was to prospectively evaluate the outcome of submuscular bridge plating (SBP) of predominantly length-unstable femoral shaft fractures in children between 6 and 13 years of age, who are treated in a South African tertiary hospital setting
The findings of the current study show that in a South African tertiary hospital setting, good results can be achieved when treating length-unstable paediatric femoral shaft fractures with SBP
Summary
Femoral shaft fractures are among the most common major paediatric orthopaedic injuries,[1] accounting for between 1.4 and 1.7% of all fractures seen in the paediatric population.[2]. The majority of paediatric femoral shaft fractures have been managed conservatively,[3] by means of balanced traction, splints/harnesses and/or hip spicas.[3] most paediatric femoral fractures unite, complications including delayed union, non-union, re-fracture, leg length discrepancies and/or angular deformities are reported.[1] The preferred approach for children of school-going age (6–13 years) appears to be surgical, enabling early mobilisation and return to school. Methods: All patients with predominantly length-unstable femoral diaphyseal fractures who were treated between 1 January 2011 and 31 December 2012 were included in this study. Conclusion: SBP provides reliable outcomes in children with diaphyseal femoral fractures and is our preferred method of fixation for a) length-unstable fractures; b) fractures close to the metaphysis; and c) children weighing more than 45 kg
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