Femur In Adolescents Research Articles

Closed Fracture Middle Shaft Femur Treatments for Adolescent Patients, with a Focus on Union Rates and Complications: A Systematic Review

Introduction: Femoral shaft fractures are common in children, with intramedullary nailing being the "gold standard" due to its short hospital stay, fast fracture union, and early functional use. Submuscular plating is an alternative, but the choice for adolescents remains unclear. Herein, we systematically review the union rates after submuscular plate or Intramedullary elastic nail treatment to treat closed fracture middle shaft femur and the other clinical outcomes of these methods. Methods: We conducted clinical data searches in PubMed, ScienceDirect, and ResearchGate. The studies included were RCT or cohort studies that assessed the outcomes of intramedullary nailing and submuscular plating in treating adolescent femur fractures with limitation studies published during the years 2008-2023 and using English as its language. Results: Nine studies of 390 cases were included in this review, consisting of 155 cases treated with submuscular plating and 235 with intramedullary nailing. The average time of bone union in 155 patients was 2.71 months, while 235 cases had a faster union time, with an average of 2.37 months. The other complications reviewed were malunion, nonunion, delayed union, length-leg discrepancy, coronal angular deformity, sagittal angular deformity, decreased ROM, implant prominence, implant failure, and reoperation rates. Conclusion: This study found that intramedullary nailing and submuscular plating are safe, feasible, and successful treatments for adolescent femur shaft fractures. Submuscular plating was more effective than ESIN but had a higher risk of complications. Future clinical trials should compare outcomes with a more specific population. Keywords: adolescent, intramedullary nailing, midshaft femur fracture, submuscular plating

Results of the Pediatric Shaft Femur Fracture Treated with Closed Rigid Lateral Trochanteric Entry Intramedullary Nail in North Indian Population

Objectives The femoral shaft fractures constitute 1.6% of the pediatric fractures. Intramedullary nailing is a common mode of fixation in older children and adolescents. The rigid intramedullary locking nail is a preferred choice over flexible nails in overweight patients and children older than 11 years of age. The adolescent age group with skeletal immaturity deserves special attention from the surgeons because of grave complications like avascular necrosis of the femur head and angular deformities. The aim of this study is to report the outcome of an adolescent femur shaft fracture treated with a rigid intramedullary interlocking nail in North Indian patients. Material and Methods This is a retrospective analysis performed by retrieving records of 19 patients. Patients with open fractures, polytrauma and neurovascular injuries were excluded. The preoperative and post-operative radiographic orthogonal views were analyzed to assess parameters like alignment, union and avascular necrosis (AVN). Results The mean age was 12.3 years. The mean follow-up was 1.5 years. The average time for union was 8 weeks. All the fractures were united in an acceptable alignment and rotation. There was no avascular necrosis, angular deformity and infection. The mean femur length discrepancy was 7 mm. Conclusion The rigid intramedullary interlocking nail is a valuable option for the fixation of femoral shaft fractures in an adolescent age group with a good union rate and minimal complications.

Posterior femoral condylar separation: Is it a particular type of osteochondritis dissecans in adolescents?

Introduction. Dissecting osteochondritis (RO) is based on damage to the subchondral bone, leading to its detachment and sequestration separately or together with articular cartilage with the possible formation of a free bone-cartilage fragment. The disease occurs more often in adolescents, accompanied by an increased risk of early arthrosis of the knee joint. Chronic traumatization of the subchondral bone leads to insufficient blood supply to a certain area of the growth zone of the secondary point of ossification of the femoral epiphysis, to ischemia and subsequent necrosis of the subchondral bone, which, according to modern literature, is the leading cause of the formation of the lesion. The typical localization of the RO focus is the lateral part of the medial condyle of the femur along the supporting surface. The present clinical analysis presents cases of atypical localization of dissecting osteochondritis with clinical features, specific signs on MRI, as well as various tactical approaches to treatment.Material and methods. This clinical review presents 3 cases of sequestration of the posterior lateral condyle of the femur in adolescents. Despite the similarity of the clinical picture and the MRI data, the features of the foci of RO were found in all children, which determined the need for an individual approach to therapeutic tactics. All children required surgical treatment, which was performed in the Department of Traumatology and Orthopedics of the N.F. Filatov DGKB in different volumes in each case: from transchondral osteoperforations and fixation of an osteochondral fragment with a screw to debridement of a fragmented focus with removal of osteochondral fragments.Results. All 3 clinical cases are united by atypical localization of the focus in the posterior lateral condyles of the femurs, the clinical course of the disease in the form of a low-intensity long-term pain syndrome, as well as the results of MRI of the knee joint. Most researchers adhere to the classical multifactorial etiological theory of dissecting osteochondritis, according to which the main mechanism of the origin of the lesion is mechanical overload of the subchondral bone with subsequent disruption of blood supply in it at the border with the secondary point of ossification of the femoral epiphysis. However, there is also data in the literature on congenital ossification disorder in the cartilaginous part of the growth zone of the secondary ossification point as the morphological basis of dissecting osteochondritis. The presented clinical cases cast doubt on the generally accepted model of primary damage to the subchondral bone as the only possible cause of the formation of the focus of RO, since patients have, among other things, signs of impaired ossification of the secondary ossification point of the femoral condyle, in one of whom a violation of ossification of the secondary ossification center was also determined in the patella in the form of patella bipartita.Conclusion. Inspite of all similarities connecting these cases there is still lack of data to judge about separate type of the OCD because every separate type of disease usually have particular morphological basis. There is a need of partial biopsy of these lesions to confirm or refute our hypothesis of posterior condylar separation being separate type of OCD. However these cases undoubtedly require particular managementwith special attention to timing of appropriate diagnostic procedures and surgical management to perform in time prior to osteochondral fragment separation. In case of the absence of any complaintswith particular MRI appearance of fragmented bone in the lesion with impaired ossificationindividual treatment planneeds to be defined.

Humerus nail for tibial reconstruction in adolescent with osteogenesis imperfecta – A rare surgical case report

Osteogenesis Imperfecta (OI) is a rare connective tissue disorder known for excessive bone fragility caused by collagen mutations. The common orthopaedic problems related to bone fragility include frequent multiple bone fractures, progressive deformity of long bones leading to impaired ambulation. Surgical correction of long bone deformities in OI is conventionally done using distraction osteogenesis (illizarov fixator), elastic intramedullary nailing, rigid extramedullary fixation using plates, after osteotomy. Intramedullary fixation appears to be an ideal choice for correction of recurrent deformity in the long bone and the devices used previously include telescoping rods, single or dual non-elongating nails (rush nail, TENS). Recently in a case report of 3 individual patients, a humerus nail has been used to reconstruct femur in adolescents with OI. We report a case of humerus nailing for reconstruction of tibia in an adolescent OI male with excellent outcomes which is first of its kind and not reported previously by any other authors.

Team Approach: Osteosarcoma of the Distal Part of the Femur in Adolescents.

* Osteosarcoma, while rare, is the most common primary bone sarcoma and accounts for up to 10% of all new pediatric cancer diagnoses annually in the United States.* Most commonly, osteosarcoma affects the distal part of the femur and occurs as a high-grade intramedullary (conventional) subtype.* Patients with osteosarcoma are managed with a multidisciplinary team approach. Often, an orthopaedic oncologist initiates the workup after making a presumptive diagnosis on the basis of classic clinical and radiographic findings. Advanced imaging and a tissue biopsy are performed to evaluate the extent of disease and to histologically confirm the diagnosis. Musculoskeletal radiologists and pathologists are key team members who evaluate the imaging and tissue samples to make a definitive diagnosis, establish a prognosis, and help the clinicians to develop a treatment plan. Medical/pediatric oncologists are essential team members who provide the appropriate neoadjuvant and adjuvant chemotherapy treatment and assist with long-term surveillance to monitor for local or distant relapse. Orthopaedic oncologists develop and execute a plan for resection of the tumor followed by appropriate reconstruction.* The current standard of care for distal femoral osteosarcoma is neoadjuvant chemotherapy followed by limb salvage for the surgically resectable tumor, reconstruction of the bone and soft-tissue defect, and adjuvant chemotherapy.* The survival rate for patients with isolated osteosarcoma is approximately 70% and has not substantially improved in >25 years.

Bilateral Supracondylar Femoral Stress Fractures in an Adolescent: A Case Report

Bilateral supracondylar stress fractures of the femur in adolescents is a rare presentation. Due to the uncommon and non-specific presentation there is a high risk of misdiagnosis and thus detrimental complications. We report a case of bilateral supracondylar femur stress fractures in an 18 year old male of Somalian ethnic background who presented to our institution with a right oblique supracondylar fracture of the femur with evidence of sclerotic fracture edges. The patient was found to have symmetrical bilateral stress fractures of the femur which was missed in primary care and as a result of this weakening it ultimately lead to a fracture. Although stress fractures are most commonly seen in the osteoporotic population, other factors include: exercise type, anatomical and hormonal variables. Our case report highlights predisposition to stress fractures and the importance of heightened clinical suspicion when faced with adolescents presenting with chronic musculoskeletal pain.

Bilateral Supracondylar Femoral Stress Fractures in an Adolescent: A Case Report

Bilateral supracondylar stress fractures of the femur in adolescents is a rare presentation. Due to the uncommon and non-specific presentation there is a high risk of misdiagnosis and thus detrimental complications. We report a case of bilateral supracondylar femur stress fractures in an 18 year old male of Somalian ethnic background who presented to our institution with a right oblique supracondylar fracture of the femur with evidence of sclerotic fracture edges. The patient was found to have symmetrical bilateral stress fractures of the femur which was missed in primary care and as a result of this weakening it ultimately lead to a fracture. Although stress fractures are most commonly seen in the osteoporotic population, other factors include: exercise type, anatomical and hormonal variables. Our case report highlights predisposition to stress fractures and the importance of heightened clinical suspicion when faced with adolescents presenting with chronic musculoskeletal pain.

Adolescent Physical Activity and Bone Strength at the Proximal Femurin Adulthood

Physical activity (PA) enhances bone structural strength at the proximal femur in adolescence, but whether these benefits are maintained into early adulthood remains unknown. The purpose of this study was to investigate whether males and females, described as active, average, and inactive during adolescence, display differences in structural strength at the proximal femur in early adulthood (20-30 yr). One hundred four participants (55 males and 49 females) from the Pediatric Bone Mineral Accrual Study (PBMAS) were categorized into adolescent PA groupings (inactive, average, and active) using the Physical Activity Questionnaire for Adolescents. Cross-sectional area and section modulus (Z) at the narrow neck, intertrochanter, and femoral shaft (S) sites of the proximal femur were assessed using hip structural analysis in young adulthood from femoral neck dual-energy x-ray absorptiometry scans. Group differences were assessed using ANCOVA, controlling for adult height (Ht), adult weight (Wt), adolescent bone geometry, sex, percentage adult total body lean tissue (LTM%), and adult PA levels. Active adolescents had significantly greater adjusted bone geometric measures at all sites than their inactive classified peers during adolescence (P < 0.05). In adulthood, when adjusted for Ht, Wt, adolescent bone geometry, sex, LTM%, and adult PA levels, adolescent participants categorized as active had significantly greater adjusted adult bone geometric measures at the proximal femur than adult participants who were classified as inactive during adolescence (P < 0.05). Skeletal advantages associated with adolescence activity appear to confer greater geometric bone structural strength at the proximal femur in young adulthood.

50 years ago in CORR: Slipped capital femoral epiphysis. Wiliam J. Schnute, MD, CORR 1958;11:63-80.

50 years ago in CORR: Slipped capital femoral epiphysis. Wiliam J. Schnute, MD, CORR 1958;11:63-80.

The Classic: Epiphyseal Coxa Vara or Displacement of the Capital Epiphysis of the Femur in Adolescence

This Classic Article is a redacted reprint of the original work by J.A. Key, "Epiphyseal coxa vara or displacement of the capital epiphysis of the femur in adolescence." (Note the case reports and associated figures were deleted but are available in the supplemental reprint of the original article available online.) An accompanying biographical sketch of J.A. Key is available at DOI 10.1007/s11999-013-2907-9. The classic article is reprinted courtesy of The Journal of Bone and Joint Surgery from Key JA. J Bone Joint Surg. 1926;8:53-117.

Does the Extent of Prebending Affect the Stability of Femoral Shaft Fractures Stabilized by Titanium Elastic Nails? A Biomechanical Investigation on an Adolescent Femur Model

Elastic stable intramedullary nailing (ESIN) is a common procedure for stabilization of femoral shaft fractures in childhood. Prebending of the nail is generally recommended to achieve optimal nail tension at the fracture site. To our knowledge there are no published data on the effects of prebending on stability. The purpose of this biomechanical study was to compare the effects of different degrees of prebending on the stability of transverse femoral fractures after ESIN using a bone model. Standardized transverse midshaft fractures were created in 20 synthetic, biomechanically validated adolescent bones (4th Generation Composite Femur--Sawbones Europe AB, Sweden) that were stabilized with 2 titanium nails (TEN) each (4 mm diameter, Synthes) and inserted in standardized retrograde technique. The 4 test series addressed nail prebending at 0 degree, 30 degrees, 45 degrees, and 60 degrees. The models were tested biomechanically in 4-point bending in the coronal and sagittal planes, relative stiffness was determined and analyzed statistically. The level of significance was set at P < 0.05. Comparison of the individual groups showed no significant differences in stiffness for different degrees of prebending in the coronal plane. Significantly reduced stiffness was found in the sagittal plane for the group with 60-degree prebending compared with the 0-degree, 30-degree, and 45-degree prebending groups. Intragroup comparison in the coronal and sagittal planes yielded a significantly reduced stiffness in the sagittal plane compared with the coronal plane in the group with 60-degree prebending. The 45-degree prebending group showed a similar tendency and in the 0-degree and 30-degree prebending groups there were no significant differences. On a synthetic bone model, prebending of TEN was found to affect the stability of transverse fractures of the femoral shaft, whereby indiscriminate prebending will reduce stability in the sagittal plane.Despite limited extrapolation of the findings to the in vivo situation, it can be stated that prebending of TEN by 0 to 30 degrees offers the greatest stability in the coronal and sagittal planes for transverse fractures of the femoral shaft.

Submuscular plating of femoral fractures in children: the importance of anatomic plate precontouring

Despite many treatment options, the treatment of metaphyseal pediatric femoral fractures remains to be controversial. Fixation of most metaphyseal femoral fractures in older children is difficult to perform. Recently, bridging fixation of such fractures by submuscular plating has become popular. Plate precontouring as close as possible to anatomic bony structure is important, as the femur will subsequently reduce to the contour of the plate with screw placement. Our technique is using plates that are anatomically precontoured to a cadaver adolescent femur to ensure proper postoperative alignment. In this study we evaluate the effectiveness of submuscular plating performed in our institution using this technique, in 11 patients. All fractures united with good alignment. No major complication occurred. In conclusion, submuscular plating of adolescent femoral fractures with precontoured plates is an effective, predictable, and safe procedure.

Preterm Birth and Adolescent Bone Mineral Content

The purpose of this study was to determine the influence of preterm low birth weight on bone mineral content in adolescence. In 2007 to 2008, data on adolescents were obtained for study, including 16 females and 25 males who were born preterm (≤37 weeks' gestation) between October 1, 1989, and December 31, 1995, with a birth weight of less than 1850 g. Preterm low-birth-weight individuals were age- and sex-matched to full-term (>37 weeks) normal-birth-weight (>2500 g) controls. Total body, hip, and spine bone mineral content (BMC) was assessed using dual energy X-ray absorptiometry. Male preterm individuals had less BMC at the proximal femur in adolescence compared with controls ( p < 0.05). However, once adjusted for age, maturity, height, weight, physical activity, and diet, there were no differences between groups ( p < 0.05) in any bone parameters. These findings suggest that preterm birth and low birth weight did not influence bone accrual in these individuals at adolescence.

Biomechanical Evaluation of Retrograde Intramedullary Stabilization for Femoral Fractures

Retrograde stabilization of mid-diaphysis adolescent femur fractures has shown excellent biomechanical stability. However, it is unclear whether adequate stability is maintained for distal femur fractures using the retrograde approach compared with the clinically recommended antegrade approach. The purpose of this study was to evaluate the biomechanical stability of retrograde and antegrade nailing for mid-diaphyseal and distal diaphysis femoral fractures. Twenty adolescent-sized synthetic femurs were randomly assigned to fracture location and surgical approach groups. Comminuted fractures were simulated at the mid-diaphysial level and 4 cm proximal to the distal physis. The retrograde approach used 2 c-shaped 3.5-mm titanium nails. The antegrade used c and s 3.5-mm nail configurations. Both techniques achieved maximum nail divergence at the level of the fracture. Biomechanical testing was conducted to determine differences in torsional range of motion (degrees)and failure load (N) at 5 mm. These data were analyzed with a 2-way analysis of variance (p < 0.05). In torsion, there were no differences related to surgical approach or fracture level. For axial compression to 5 mm, the antegrade approach required significantly greater force to achieve 5 mm of compression compared with the retrograde approach. The mid-diaphyseal fracture required significantly greater force to achieve 5 mm of compression compared with the distal diaphysis group. For maximum stabilization of a distal femur fracture, c- and s-shaped nails placed in the antegrade position is suggested. Surgical decision making regarding the use of either the antegrade or retrograde approach will be influenced by both the stability provided (antegrade) and the ease of insertion (retrograde).

Fatigue Fracture of the Distal Femur in Adolescence: A case Report

Fatigue Fracture of the Distal Femur in Adolescence: A case Report

Technique of intramedullary fixation of pediatric and adolescent femur fractures using rush pins

Rush pins provide stability and alignment of pediatric and adolescent femur fractures, which allows rapid mobilization and healing. The smooth stainless steel pins are inserted with minimal surgical and biologic trauma. Medullary reaming and filling of the canal are not needed to obtain fixation. The preparation and insertion technique of these semirigid pins is exacting.

Compression Plating for Child and Adolescent Femur Fractures

Twenty-five children ranging in age from 6-16 years underwent AO compression plate fixation for treatment of a femur fracture. Generally, the most common reason for plate fixation was to simplify nursing care and rehabilitation of children with an associated severe head injury or polytrauma. Twenty-three fractures healed in 11 weeks on the average, most by periosteal bone formation. Leg length discrepancy was not a clinical problem. Nursing care and polytrauma rehabilitation were simplified in all children. We believe that plate fixation is a reasonable treatment option for femoral fracture care in children aged less than 11 years with severe head injury or associated polytrauma.

Compression Plating for Child and Adolescent Femur Fractures

Compression Plating for Child and Adolescent Femur Fractures

Roentgen Examination of the Proximal End of the Femur in Adolescents

Roentgen Examination of the Proximal End of the Femur in Adolescents

Roentgen Examination of the Proximal End of the Femur in Adolescents

Roentgen Examination of the Proximal End of the Femur in Adolescents