Femoral Shaft Fractures In Children Research Articles

Pediatric femoral shaft fracture requiring revision surgery for nonunion associated with vitamin D and K deficiencies: a case report

BackgroundNonunion of femoral shaft fractures in children is rare, and there is no clear treatment protocol. In this case report, a pediatric femoral shaft fracture that developed in nonunion due to vitamin deficiency after osteosynthesis, which was successfully treated with vitamin augmentation and replacement with a rigid antegrade intramedullary nail, is described.Case presentationThe patient is an 11-year-old Japanese girl. She injured her right femoral shaft fracture when she hit a wall after kickboarding down a hill and underwent osteosynthesis with a titanium elastic nail. Six months postoperatively, she developed nonunion, was found to be deficient in vitamins D and K, and was started on vitamin supplementation. She underwent replacement with a rigid antegrade intramedullary nail at 7 months postoperatively, and bone union was achieved 3 months after reoperation.ConclusionWhen delayed union of a fracture is observed postoperatively, even in children without underlying disease, the cause of the problem must be investigated and treated promptly.

Prospective study of surgical management of femoral shaft fractures in children using tens nail

Background: Pediatric femoral shaft fractures are uncommon, constituting less than 2% of all fractures in children; yet they are a significant burden on healthcare systems and families as they are the most common fractures requiring hospitalization in children. In the recent studies, technique of flexible stable intra medullary pinning using titanium pins which is now popularly known as TENS has become the choice of operative management for pediatric femoral shaft fractures. We conducted a clinical prospective study on the use of Titanium Elastic Nailing System (TENS) for the treatment of femoral shaft fractures in children. Methods: This prospective study was carried out at Al-Ameen Medical College and Hospital, Vijayapura. Forty patients (32 males and 8 females) aged between 5-15 years with diaphyseal femur fracture were included in our study. Patients were treated with closed reduction and internal fixation with TENS. They were followed up for 6 months both clinically and radiologically. The functional outcome was evaluated using Flynn’s scoring criteria. Results: Forty patients were followed up for 6 months and their results were evaluated. The functional outcome using Flynn’s criteria was excellent in 24 patients, satisfactory in 14 patients and poor in 2 patients. Complications observed were limb length discrepancy, knee stiffness, superficial infection and nail protrusion. Conclusions: TENS has the advantages of early union, early mobilization, and manageable complications, making it an excellent choice for treating paediatric shaft femur fractures in patients aged 5 to 15 years.

Recovery of Gait in Children and Adolescents After Pediatric Femoral Shaft Fracture Treated with Intramedullary Nail Fixation: A Longitudinal Prospective Study.

Femoral shaft fractures in school-aged children are commonly treated with intramedullary nail fixation. Outcomes such as time to healing, alignment and non-union, leg length discrepancy, and refractures, and other complications are often reported based on radiographic findings. There are limited reports on physical function, including objective quantitative measures. The aim was to study the progress and recovery of gait after femoral shaft fracture in children and adolescents. Inclusion criteria were individuals 6 to 16 years of age with a femoral shaft fracture treated with intramedullary nails. Exclusion criteria were pathologic fractures and other physical impairments or injuries that influenced gait.At 6 and 12 weeks, assessments of mobilization and weight bearing were performed at clinical hospital follow-ups.At 3, 6, 9, and 12 months, physical examinations of passive range of motion, stair walking, and three-dimensional gait analysis, including temporospatial, movement (kinematics), and force (kinetics) data, were performed. Seventeen participants, with a median of 9.2 (interquartile range 6.5 to 11.3) years of age were included. At 6 weeks, 14 of 16 (88%) used walking aids and at twelve weeks, 25% did. Sixty-nine percent could walk up and down stairs at 6 weeks and 100% at 12 weeks. At 3 months, 3 participants walked with a speed below 100cm/second and had clear deviations in gait pattern compared with the control group. Three participants had no deviations in gait patterns at 3 months. Gait patterns had normalized in most participants at 6 months. Hip and knee extension moments were decreased up to 6 months compared with the control group. Hip extensor muscle work was increased on the fractured side compared with the control group. Early recovery, between 6 and 12 weeks postoperatively, was noted in basic performance tests after femoral shaft fractures in children and adolescents. Three-dimensional gait analysis revealed normalization of gait patterns at 6 months. Information on the expected time and degree of recovery of physical function could guide the rehabilitation process. Level III.

Femoral Shaft Fractures in Children: Exploring Treatment Outcomes and Implications.

Femoral shaft fractures significantly impact children and families, posing a significant challenge for pediatric patients.The prevalence of limb shortening in femur shaft fractures treated with hip spica casting in our group, however, has not been the subject of many recent investigations. By comparing the prevalence of limb shortening to various age groups and common pediatric injury patterns, this research seeks to close this information gap. This research, which lasted six months and was done at the Orthopedics Unit of Khyber Teaching Hospital Peshawar, Pakistan, included 129 childrenwith closed femur shaft fractures who were between the ages of one and six. Clinical assessments, radiological examinations, and hip spica casting, all supervised by experienced orthopedic surgeons, were carried out. Senior postgraduate trainees oversaw the study's findings. The results unveiled key insights into the study population. Among the findings, 33% (n=43) of the children were aged one to three years, while 67% (n=86) fell within the three to six years age range. Gender distribution revealed that 72% (n= 93) were male. In terms of mechanism, 22% (n=28) of fractures were attributed to road traffic accidents, 69% (n=89) were the result of falls, and 5% (n=12) were due to other causes. Notably, 19%(n=29) of the children exhibited limb shortening. This study contributes significantly to the understanding of femur shaft fractures in children, shedding light on their complex dynamics. The study enhances our understanding of pediatric femur shaft fractures. We found that 19% of children exhibited limb shortening, underscoring the need for targeted treatment strategies. These insights can significantly improve patient care and treatment protocols for this challenging condition, benefiting both children and their families.

Efficacy of Single Titanium Elastic Nail in the Treatment of Child Femur Fractures.

Femoral shaft fractures in childhood constitute an important part of emergency visits to orthopedic clinics. The aim of this study was to investigate the efficacy and reliability of a method in the treatment of simple fractures in the middle of the femoral diaphysis in patients with multiple injuries or in the treatment of cases with a medullary canal that is too narrow for two nails, with a single stretch nail thicker than half the diameter of the canal. Between July 2002 and November 2006, examinations were made of 11 femoral fractures in 11 patients who were admitted to the pediatric emergency department of Tepecik Training and Research Hospital with a diagnosis of femoral fracture and who were hospitalized and treated with a single flexible intramedullary titanium nail. In the follow-up, no problem was found in terms of union and length difference in any of the cases, except for a10º varus deformity present after surgery in one case. Elastic intramedullary nailing is an effective method in the treatment of simple femoral fractures in children. A single elastic nail provides adequate stability following open reduction with minimal incision in patients whose short operating time must be kept short such as those with head trauma, thoracic trauma, or intra-abdominal pathology, or patients with a narrow medullary canal where two flexible nails cannot pass. We think that it is a feasible method because it causes minimal soft tissue damage.

Current practices in the management of closed femoral shaft fractures in children: A nationwide survey among Dutch orthopaedic surgeons

BackgroundThere remains a lack of high-quality evidence on the treatment of pediatric femur shaft fractures. Therefore, treatment choices may still be based on personal preference of treating surgeons. To gain insight in considerations regarding treatment options, we conducted a survey among Dutch trauma and orthopedic surgeons. MethodsThis survey was conducted in 2020, regarding treatment considerations for closed femoral shaft fractures in children in different age and weight groups. ResultsOne hundred forty-two surgeons were included in the analysis. 31% of participating surgeons considers surgical fixation in children of 2–4 years old, compared to 83% in children of 4–6 years old. In terms of weight, 30% considers surgery in children of 10–15 kg, compared to 77% considering surgery in children weighing 15–20 kg. While most surgeons find traction and spica cast suitable options for children younger than 4 years, a minority also considers these treatment modalities for children older than 4 (traction: 81% versus 19%, spica cast 63% versus 29% respectively). 33% of surgeons considers ESIN under 4 years of age, compared to 88% in children older than 4. ConclusionAn age of 4 years and a weight of 15 kg seem to be cut off points regarding preference of non-surgical versus surgical treatment of closed femoral shaft fractures. There is a wide range of ages and sizes for which treatment options are still being considered, sometimes differing from the national guideline. This questions guideline adherence, which may be due to a lack of available high-quality evidence.

TENS in Femoral Shaft Fractures of Children

Background: Pediatric femoral shaft fractures are one of the common fractures that we encounter in the orthopedics outpatient department. These fractures have various treatment options ranging from traction and early hip spica casting to elastic titanium intramedullary nails [titanium elastic nailing system (TENS)] and reamed intramedullary nails. In this study, we are evaluating the functional outcome and results following the use of flexible intramedullary nails and conservative management for femoral shaft fractures in children.
 Methods: This was a prospective observational study which was carried out in a tertiary care hospital from October 2015 to May 2017 for two groups of children who sustained traumatic femoral shaft fractures. A total of 40 patients were taken into consideration with 20 patients each in two groups.
 Results: The male-to-female ratio was 2.6:1 in our study population. The overall post-operative complication rate was more in the TENS group. Besides, we found that the TENS group of patients had a less limb length discrepancy (LLD) (P = 0.004) and a lower degree of angular deformity (P = 0.36).
 Conclusion: TENS demonstrated advantages including sufficient axial stability, early mobilization, and more rapid return to function than spica cast treatment; however, it had the drawback of possible infection and pin site irritation. Overall, TENS offers a minimally invasive method for treatment of the femoral shaft fractures in children which stands superior to traditional spica casting.

Can Rigid Femoral Nailing be used for Pediatric Femoral Shaft Fracture in Children 8 to 10 Years? Use of RIN in Patients With Femoral Shaft Fracture.

The treatment modalities for pediatric femoral shaft fractures are determined by their age, weight, and fracture pattern. Rigid intramedullary nailing (RIN) is usually recommended for patients >11 years of age, and elastic intramedullary nailing (EIN) has been used for patients under 10 years. However, little is known about the use of RIN in patients aged 8 to 10 years. We examined the differences in patients with femoral shaft fractures who were treated with EIN or RIN in terms of (1) fracture healing; (2) changes of anatomic parameters; and (3) related complications. We retrospectively reviewed 54 patients between 8 and 10 years of age, with femoral shaft fractures, who were treated with either EIN or RIN between 2011 and 2020. Lateral trochanteric entry was used for RIN procedure. The mean follow-up period was 26.4 months (range, 6 to 113mo). There were 17 patients in the EIN group and 37 patients in the RIN group. The mean age at the time of surgery was 1 year younger in the EIN group (P<0.01). The mean weight of the patient was significantly heavier in the RIN group compared with the EIN group. Complete union of the fracture was achieved slightly faster in the RIN group at 3.4 months compared with 3.7 months in the EIN group (P=0.04). There were no clinically significant changes of the anatomic parameters in either group, including neck shaft angle and articulotrochanteric distance. There was no evidence of avascular necrosis at the time of final follow-up for either group. There were no significant differences in postoperative complications between the groups. RIN using lateral trochanteric entry is a feasible surgical option for femoral shaft fractures in patients 8 to 10 years of age that are heavier than 40kg or with unstable fracture patterns. Level III, retrospective cohort study. See the Guidelines for Authors for a complete description of levels of evidence.

Elastic Stable Intramedullary Nailing and Fixation with Titanium Elastic Nail in Displaced Femoral Shaft Fractures in Children

Elastic Stable Intramedullary Nailing and Fixation with Titanium Elastic Nail in Displaced Femoral Shaft Fractures in Children

Do All Pediatric Femoral Shaft Fractures Need a Computed Tomography Scan of the Ipsilateral Femoral Neck? Calculating the Incidence of Concomitant Femoral Neck and Shaft Fractures

In adults, the incidence of ipsilateral femoral neck fractures in the setting of femoral shaft fractures is reported to be as high as 9%; however, scant literature exists on the same clinical scenario in pediatric/adolescent populations. Therefore, the purpose of this study was to investigate the incidence of ipsilateral femoral neck fracture in the setting of femoral shaft fractures in children and adolescents treated in pediatric hospitals across the United States. The Pediatric Health Information System database was queried for patients aged 18 years or younger who were treated for a femoral neck, femoral shaft, and pertrochanteric femur fractures through an emergency department, inpatient, ambulatory surgery, or observation visit. Patients were identified using ICD-9 and ICD-10 diagnosis codes. Data from 49 pediatric hospitals between the years 2002 and 2020 were included. Incidence was calculated as the number of cases including the event divided by the total number of cases. A total of 90,146 records were identified from a cohort of 55,733,855 (0.16%). Distal femur fractures, pathologic fractures, and periprosthetic fractures were excluded, resulting in 65,651 unique cases. Of the 65,651 cases, 7104 (11%) were identified as isolated neck fractures. The combined incidence of femoral neck or pertrochanteric femur fractures in the setting of a femoral shaft fracture was 82.3 per 10,000 cases (0.82%). Only 283 cases of concomitant femoral neck and shaft fractures were found among 55,169 femoral shaft fractures (0.5%). The incidence of ipsilateral femoral neck or pertrochanteric femur fractures in the setting of a femoral shaft fracture is 82.3 per 10,000 patients (0.82%) based on data from Pediatric Health Information System-participating institutions. The incidence of femoral neck/pertrochanteric femur fractures and femoral shaft fractures in children and adolescents is more than 10 times lower than reported for adults; therefore, the routine use of advanced diagnostic imaging in pediatric patients with femoral shaft fractures should be considered cautiously. Level IV; cross-sectional analysis.

Length Unstable Femoral Shaft Fractures in Children: It's Time for a New Definition.

Length Unstable Femoral Shaft Fractures in Children: It's Time for a New Definition.

Paediatric Femoral Diaphyseal Fractures in a South Wales Tertiary Centre: An Account of Trend in Management and Complications Over 16 Years.

Femoral shaft fractures in children have seen a number of interesting developments over the past 20 years. This is a retrospective cohort study looking into epidemiological and outcomes data of femoral shaft fractures in children treated at a tertiary centre in Wales from 2005-2021. Over a period of 16 years, there has been a significant increase in the number of rigid or elastic nailing and submuscular plating, coinciding with a dramatic reduction of external fixation for definitive treatment of diaphyseal femoral fractures. All patients above five years of age underwent operative fixation, with elastic or rigid intramedullary nailing the treatment of choice. Following multiple linear regression with 16 possible explanatory factors, this study found a statistically significant increase in time to union for open fractures, pre-operative translation, and operation time. Furthermore, there was a significant increase in post-operative leg length discrepancy for right versus left-sided fractures. Overall complication rates were 4% for minor and 8% for major complications. Complication rates were lowest for rigid intramedullary nailing and highest for external fixation. No cases of avascular necrosis were found for 27 rigid intramedullary nails inserted. Overall this study reports treatment choices and outcomes in keeping with current trends in management for paediatric femoral shaft fractures.

Short Term Clinical, Functional and Radiological of Fixation of Paediatric Femoral Shaft Fracture by Titanium Elastic Nail in Paediatric Patients

Introduction: Femoral shaft fracture is the most common major paediatric orthopaedic. For generations traction and casting was the standard treatment for all femoral shaft fractures in children. Elastic stable intramedullary nailing is one for treating these fractures and has a reliable methodology. Over the past two decades the advantages of fixation and rapid mobilisation have been increasingly recognised. Objective: To evaluate the short term clinical, functional and radiological outcome of intramedullary fixation of displaced femoral shaft fractures in skeletally immature children using titanium elastic nails. Methods: A prospective study was conducted in the Department of Ortho Surgery, National Institute of traumatology and orthopedic rehabilitation (NITOR), Dhaka, Bangladesh from July to December 2020. 52 femoral shaft fractures in child aged 6-14 years were fixed with titanium intramedullary elastic nail in the department of Orthopaedics, NITOR, Bangladesh. Two nails of proper and equal diameter were used for fracture fixation. No external splint was used after surgery. Outcomes assessed on the basis of Flynn et al., scoring criterion. Results: The results of the 52 included in our study. All patients achieved complete healing at a mean of 9.1 (Range 8- 10) weeks. 44 fractures were reduced by closed means but 8 needed open reduction. No major complication was recorded. Most common minor complication was entry site skin irritation recorded in 8 patients. 84.61% had excellent result and 15.38% had satisfactory. Conclusion: The treatment of paediatric shaft femur fracture has been drastically changed over the last two decades to internal fixation by elastically stable intra- medullary nail (ESIN). It allows early ambulation and shorter hospital stay and higher parent satisfaction. It also provides flexural, translational and rotational stability as well.

Leg length discrepancy after skeletal maturity in patients treated with elastic intramedullary nails after femoral shaft fractures in childhood.

Purpose:The purpose was to study radiographic and perceived leg length discrepancy after skeletal maturity in patients treated for femoral shaft fractures with elastic stable intramedullary nails in childhood.Methods:Thirty-five adults underwent standing radiographs and answered a questionnaire regarding perception of leg length discrepancy. Demographic data, fracture characteristics, angulation, stability of fixation, and callus formation, at time of fracture, were assessed.Results:Mean age at fracture was 10.2 (4.9–16.7) years, and mean follow-up time was 11.1 (3.8–16.8) years. In 8 of 35 participants, the fractured limb was 11–15 mm longer than the non-fractured, and in 16, 1–10 mm longer. In eight participants, the fractured limb was 1–10 mm shorter than the non-fractured, and in three participants, 12–23 mm shorter. The younger the child, the greater the lengthening (Rs = −0.49, p = 0.003). The greater the femoral angulation at time of fracture, the greater the shortening (Rs = 0.42, p = 0.013). There was no significant correlation between stability of fixation or callus formation 1 month postoperatively and radiographic leg length discrepancy after skeletal maturity. Fourteen (40%) had perception of leg length discrepancy at follow-up, of whom eight had a radiographic leg length discrepancy of 10–24 mm.Conclusion:Treatment with elastic stable intramedullary nail of femoral shaft fracture in childhood may result in radiographic leg length discrepancy. Younger children were more prone to lengthening and should possibly be assessed before skeletal maturity. The degree of fracture stability or callus formation at the time of fracture did not significantly affect leg length discrepancy. Perception of leg length discrepancy was not necessarily associated with a radiographic leg length discrepancy (≥10 mm).Level of evidence:level IV, case series.

Elastic Stable Intramedullary Nailing and Temporary External Fixation for the Treatment of Unstable Femoral Shaft Fractures in Children Aged 5-11 Years Old: A Retrospective Study of 28 Cases.

PurposeUnstable femoral shaft fractures (UFSFs) in children aged 5–11 years remain challenging due to their intrinsic instability. The aim of this study was to evaluate the clinical and radiographic outcomes of UFSF in children aged 5 to 11 years managed by the combined use of ESIN and temporary EF.MethodsChildren with UFSF (long oblique and comminuted) treated by ESIN and temporary EF were retrospectively reviewed. Sex, age at injury, side involved, type of fracture, presence or absence of associated lesions or neurovascular complications, type of treatment, time from trauma to surgery, duration of surgery, radiation exposure and length of postoperative immobilization were collected from the medical charts. Radiological and functional outcomes were evaluated according to Beaty's and Flynn's criteria, respectively.ResultsA total of 28 consecutive patients with closed or open (Gustilo type I or II) UFSF were reviewed (18 boys and 10 girls). The mean age at injury was 8.7 ± 1.6 years (range, 5–11); the average weight was 38.1 ± 7.6 kg (range, 26–55). The mean hospital stay was 3.7 ± 1.4 days (range, 2–7), and the mean time to EF and ESIN removal was 6.5 ± 1.1 weeks (range, 4–8) and 9.4 ± 1.6 months (range, 6–12), respectively. Twenty-seven out of 28 patients had excellent radiographic outcomes according to Beaty's criteria, and 24/28 had excellent functional outcomes according to Flynn's criteria. Overall, 4 complications (14.3%) were recorded. No statistically significant correlation was found between complication rates and sex, age, weight or fracture characteristics (P < 0.05).ConclusionsThe combined use of ESIN and temporary EF provides good clinical and radiological outcomes in children with UFSF aged between 5 and 11 years, with a reduced complication rate.

Functional outcome of elastic intramedullary nailing for femoral shaft fractures in children

Background: Pediatric femoral shaft fracture is the most frequent fracture type in orthopedic practice in which males are affected more commonly than females. Currently, intramedullary fixation for the managing of femoral shaft fracture in children is widely used worldwide, including Iraq, which overcomes most of the difficulties related to other treatment modalities. Objectives: This study aimed to determine the clinical, functional, and radiological consequences of pediatric femoral shaft fractures achieved with a titanium elastic nail system (TENS). Materials &amp; Methods: In this study, 28 children aged 5-10 years with femoral shaft fracture admitted to Shar Hospital, Sulaimaniyah, Republic of Iraq, were enrolled. Their fractures were fixed with Titanium Elastic Nail (TEN), in which a pair of the same-sized nail was used for each fracture. The outcomes were assessed using Flynn’s scoring criteria. Finally, the patients were discharged the next day and followed up after 2, 4, 8, 12 and 20 weeks of surgery. Results: Based on Flynn’s score assessment, the outcome of 85.71% of patients were excellent, 12.5% were satisfactory, and 1.79% were poor. All patients were showed a radiological unification and a conceivable full weight-bearing in a mean time of ~ 9 weeks, while their full knee variety of movement was attained in 2 months. Conclusions: TENS is a potential means to treat femoral shaft fractures in children as it is a simple, safe, minimally invasive, and physeal-protective with fewer complications and a high rate of good and excellent outcomes.

Outcome of Fractures SOF in Children Treated with Early Hip Spica: A Prospective Study

Background: In children, femoral shaft fractures are usually treated by initial performance and durability for 3 to 4 weeks, followed by an additional period of immobilization in a hip spica cast until union occurs. However, such treatment would involve prolonged hospital stays, thereby increasing the cost and occupancy of hospital beds. Early hip spica cast application of femoral shaft fractures in children is a valuable alternative to the traditional treatment method. It allows for a short hospital stay, thereby avoiding all the problems associated with prolonged hospitalization. Methods: This prospective study was conducted on 20 patients. Multicentered based non-randomized evaluations were performed in Modernized District Hospital, Joypurhat, and Rajshahi Medical College Hospital, Rajshahi, Bangladesh, from January 2020 to April 2022. With femur shaft fractures over two years. All the children of both sexes from 2 to 12 years of age with fractures shaft of the femur presented within day one of injury. Follow-up was done in OPD for up to 6 months. The functional result was assessed according to Flynn’s scoring criteria. Results: The mean age of the patient was 5.65 years, ranging from 2 to 12 years. The male-female ratio was 3:1. The mean duration of hospital stay was 4.1 days. Radiological union in all cases was achieved in a mean time of 7.65 weeks. Full weight-bearing was possible in a mean time of 10.07 weeks. The result was excellent in sixteen patients (80%), successful in two (10%), and poor in two patients (10%). Conclusions: Early spica cast is a simple, effective, and definite treatment method with minimal complications and acceptable results in the pediatric age group.

Results after skin traction for femur shaft fractures in children below the age of four years

PurposeNonsurgical management has been identified as the treatment of choice for femoral shaft fractures in children below four years of age. For various reasons, the surgical approach has become increasingly popular in recent years. The aim of this study is to report results after vertical skin traction and analyze the benefits of this technique as well as to point out advantages compared with surgery in this age group.MethodsThe authors performed a retrospective data analysis, including all patients with femoral shaft fractures below the age of four who were treated with vertical skin traction at our institution between January 2006 and December 2016.ResultsSkin traction for a femoral shaft fracture was performed for 36 patients (mean age 1.6 years; 1 day–3.5 years). The mean duration of traction was 18.5 days (14–30). Complications included soft tissue affections (n = 5), which all healed spontaneously. Consolidation was observed in all fractures. Initial axial deviations and shortening did not change during traction until consolidation (p > 0.05), and no relevant torsion deformity occurred (p = 0.01). Patients gained full weight-bearing within 12.3 days (7–40) following end of traction. At the final follow-up, after a mean of 29.3 months (12–192), leg-length discrepancy (mean 7.1 mm; 5–20) was found on radiograms in nine cases, and axial deviations (mean 7.7°; 5–25) were documented in seven cases. None of the patients had limitations in daily activities or sports.ConclusionSkin traction is a technically easy, safe, and non-invasive treatment modality for femoral shaft fractures in children below the age of four years. Strong results are obtained benefited from a high potential of growth-related correction, and in principle no anesthesia is needed. A prolonged hospitalization and socio-economic factors maintain the ongoing debate in comparison with the surgical approach.Level of evidenceLevel III, retrospective.

Operative Choice for Length-Unstable Femoral Shaft Fracture in School-Aged Children: Locking Plate vs. Monolateral External Fixator.

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.

Impact on Family Functioning of Immediate Spica Casting for Pediatric Femur Fractures: An Ecological Study

Background: Traditional treatment for femoral shaft fractures in children aged 6 months to 6 years old is closed reduction and immediate spica casting. Pediatric femur fracture and spica cast treatment place unique burdens and stresses on the family. The purpose of this study was to evaluate the impact on the family from an ecological perspective of immediate spica casting for femoral shaft fractures in children using appropriate validated family functioning questionnaires. Methods: Families of 46 children aged 0.5 to 6.0 years old who were treated with immediate one and a half leg spica casting for femur fracture were surveyed using the Impact on Family Score (IFS), the Feetham Family Functioning Survey (FFFS), and qualitative comments. The impact of spica cast treatment on family functioning was determined for multiple domains and compared between subgroups. Results: Spica cast treatment for pediatric femur fractures had major impacts on the families of 46 children with a mean age of 2.9 years (range, 0.5–6.0 years) across multiple domains. The IFS demonstrated greater impact of spica cast treatment than treatment for children with major chronic illnesses. There was a greater impact on family for school age children (5–6 years old) compared to younger children (0.5–4 years old) for the overall IFS score, the general impact IFS domain, the disruption of family IFS domain, the coping IFS domain, and the overall FFFS discrepancy score. There was greater impact on family for children of working parent(s) compared to children with a parent at home for the overall IFS score, the general impact IFS domain, the disruption of family IFS domain, the coping IFS domain, the financial impact IFS domain, and the overall FFFS discrepancy score. There was no correlation between duration of time spent in hip spica cast with either IFS or FFFS discrepancy score. Conclusions: Pediatric femur fracture and spica cast treatment can have a major impact on family functioning, particularly in school age children and in families with working parents. Providers should consider the impact of treatment on family functioning and recognize that each patient and family unit require education and varying levels of support. Education to families of children undergoing spica cast treatment may help prepare them for the various ways their household dynamics could be affected throughout their child’s treatment.