Femoral Shaft Fractures In Children Research Articles

A prospective study of early spica casting outcomes in the treatment of femoral shaft fractures in children.

We analyzed the early spica casting outcomes of 50 children age 2 to 10 years with uncomplicated femoral shaft fractures treated at Johns Hopkins Hospital between October 1987 and October 1990. Our objective was to develop criteria for the prospective identification of patients who can be safely and dependably treated with early spica casting without excessive shortening of the fracture fragments. Forty-one (82%) children had an acceptable outcome and nine (18%) had an unacceptable outcome according to our definition of > 25 mm of fracture fragment overlap at 3 to 4 weeks follow-up. A new clinical test, the telescope test, was statistically significant (p < 0.001) for association with spica casting outcome. Age, sex, fracture location, mechanism of injury, fracture type, and resting roentgenogram fracture fragment overlap were not statistically significant (p > 0.10). The telescope test had a sensitivity of 78%, a specificity of 85%, and a negative predictive value of 95% for predicting spica casting outcome. The relative risk of failing spica casting after a positive telescope test was 20.4 (95% CI, 2.74-225.10). We conclude that children 2 to 10 years of age with uncomplicated femoral shaft fractures and a negative telescope test can be safely treated with early spica casting and have a 95% change of having a successful outcome with this treatment.

Spica cast treatment of femoral shaft fractures in children--the prognostic value of the mechanism of injury.

We reviewed the data on 47 closed femoral shaft fractures in 46 children 10 years of age or less treated by early closed reduction and spica cast immobilization from 1980 through 1988. These children were followed at least through the time of fracture union, spica cast removal, and onset of unprotected weight-bearing. Treatment was defined as being primarily by spica cast immobilization if less than 7 days of skin traction preceded closed reduction and cast application. The mean age at injury was 4.4 years (range, 0.2-9.9 years). Mechanisms of injury were identified and segregated into those involving high-energy and low-energy trauma. Twelve of 23 fractures (52%) caused by high energy required at least one repeat closed reduction or other treatment to correct excessive shortening or angulation that occurred following the initial reduction. Four children required prolonged skeletal traction before reapplication of a spica cast. In contrast, only 2 of 24 fractures (8%) caused by low-energy trauma required repeat closed reduction and none required skeletal traction. Whereas the mean age of the children sustaining high-energy trauma (6.1 years) was higher than that of children in the low-energy trauma group (2.9 years), 7 of 12 fractures caused by high energy that required repeat reduction occurred in children 7 years of age or less. Femoral shaft fractures in children caused by high energy are more likely to become displaced following closed reduction and early spica cast immobilization than fractures caused by low energy. These children require careful radiographic monitoring following this type of treatment to assess fracture alignment.

Kuntscher nailing of femoral shaft fractures in children and adolescents.

We have reviewed 29 cases of very unstable diaphyseal fractures of the femur in children and adolescents treated by Kuntscher nailing. Follow up was for at least 5 years, and in most cases until after the end of growth. There were no postoperative complications, and the mean overgrowth of the femur was 7.06 mm. There was growth disturbance of the proximal femur in one case, but this did not interfere with function. We believe that Kuntscher nailing is indicated in children and adolescents with unstable high velocity fractures of the femoral shaft.

Ender nailing for Femoral Shaft Fracture in Children

Ender nailing for Femoral Shaft Fracture in Children

Plate osteosynthesis of femoral shaft fractures in children

Surgical Principles Static interfragmentary compression can be achieved by means of isolated lag screws and an additional neutralization plate. In transverse fractures axial compression is obtained by use of the selfcompressing eccentric position of the screw or the compressing device. The plate must always be positioned posterolateral (side of tension).

Functional Outcome of Femoral Shaft Fractures in Children Treated With Casting

Functional Outcome of Femoral Shaft Fractures in Children Treated With Casting

Proximal Tibial Skeletal Traction for Femoral Shaft Fractures in Children

A proximal tibial skeletal traction in the treatment of femoral shaft fractures in the growing child has been reported to result in complications such as knee pain, knee joint subluxation, and growth disturbance. For the last 15 years, the authors used a single screw (instead of the Kirschner wire) inserted in the tibia perpendicular to the surface and well below the tibial tubercle physis. With the traction applied to this screw and the leg in a 90-90 position or resting on a Braun splint, none of the previously described complications were observed. This modification of the proximal tibial skeletal traction is a simple, quick, and safe method in the treatment of femoral shaft fractures in children.

Remodelling of angular deformity after femoral shaft fractures in children.

We reviewed 28 children with unilateral middle-third fractures of the femoral shaft who had an angular deformity after union of 10 degrees to 26 degrees. At an average follow-up of 45 months (20 to 66), we measured remodelling of the proximal physis, the distal physis and the femoral shaft. The average correction was 85% of the initial deformity. We found that 74% of correction occurred at the physes and only 26% at the fracture site. Neither the direction nor the magnitude of the angulation much influenced the degree of remodelling. Younger children remodelled only a little better than older children. We conclude that in children under 13 years of age, malunion of as much as 25 degrees in any plane will remodel enough to give normal alignment of the joint surfaces.

Fractures of the femoral shaft in children treated with an AO-compression plate

Thirteen femoral shaft fractures in 12 children aged 0-15 years were each treated with an AO-compression plate. The mean age at operation was 11 (6-14) years, and all the patients were followed until closure of the growth plates. No deep infections occurred, and all the fractures healed without angulation of rotation. The mean overgrowth was 7 (-9-25) mm. All the patients had unrestricted movement in the hip and knee, and had no complaints at the follow-up examinations. We conclude that plate osteosynthesis of femoral shaft fractures in children is a safe and reliable method for internal fixation when use of traction is not possible.

Femoral Shaft Fractures in Children Treated with Early Spica Cast

We retrospectively reviewed 51 patients aged 3-11 years with femoral shaft fractures selected for treatment with early spica cast immobilization. Shortening greater than 20 mm was the most common complication, occurring in 22 (43%) of the 51 patients. Factors associated with unacceptable shortening were shortening at the time of spica cast application greater than 10 mm, shortening greater than 20 mm at initial examination, and increasing age. Achieving less than 1 cm shortening at the time of cast application and close follow-up during the first 2 weeks after cast application are advised in order to achieve an acceptable final outcome.

Treatment of femoral shaft fractures in children by external fixation

Non-operative management is still the treatment of choice for closed fractures of the femoral shaft in children. Indications for operative intervention would include: children with multiple injuries; severe soft tissue damage; cases where reduction is difficult to maintain; and children not suitable for management by traction. Since 1984, 16 children (mean age 10.3 years) have had stabilization of their femoral shaft fractures by external fixation (Monofixateur) in the Trauma Department of the Hannover Medical School. The external fixation remained in place for a mean of 63 days. Of the 16 children, 15 have been reviewed, with a mean follow-up of 28.2 months. No children who were completely managed with this fixation had any clinically relevant malalignment, but six cases had up to 2 cm difference in leg length. Our observations and experience show that external fixation is a useful alternative for the operative management of femoral shaft fractures in children. It produces good stability, is less invasive, and allows early mobilization. In order to avoid differences in leg length, we recommend a good anatomical reduction with the external fixation being carried out as early as possible.

Treatment of femoral shaft fractures in children by early spica casting: M.N. Rasool, S. Govender, and K.S. Naidoo. S Afr Med J 76:96–99, (August), 1989

Treatment of femoral shaft fractures in children by early spica casting: M.N. Rasool, S. Govender, and K.S. Naidoo. S Afr Med J 76:96–99, (August), 1989

Leg length discrepancies after femoral shaft fractures in children : M.M. Stephens, I.C.S. Hsu, and J.C.Y. Leong. J Bone Joint Surg 71B:615–618, (August), 1989

Leg length discrepancies after femoral shaft fractures in children : M.M. Stephens, I.C.S. Hsu, and J.C.Y. Leong. J Bone Joint Surg 71B:615–618, (August), 1989

乳幼児大腿骨骨幹部骨折の治療経験

乳幼児大腿骨骨幹部骨折の治療経験

Leg length discrepancy after femoral shaft fractures in children. Review after skeletal maturity.

We reviewed and radiographed 30 skeletally-mature patients after isolated closed femoral shaft fractures in childhood which had been treated conservatively. When the fracture had occurred between the ages of 7 and 13 years, the limb overgrew about 1 cm regardless of sex, upper limb dominance, age, fracture site or configuration. Excessive fracture overlap at the time of injury, but not at union, increased limb overgrowth. Angulation of the fracture remodelled in children injured under 10 years of age, but in older patients this sometimes added to limb shortening. Rotational deformities were minor and gave no symptoms. Treatment of the 7- to 13-year-old patient should aim at 1 cm overlap at union, with correction of angular deformity being more important in children over 10 years of age. This management of fractures will give a maximum leg length discrepancy of 1 cm at skeletal maturity.

Modified Functional Bracing in the Ambulatory Treatment of Femoral Shaft Fractures in Children

Thirty children aged between 2 and 10 years with fractures of the femoral shaft were involved in a prospective study of a treatment method that requires a short period of traction followed by full weightbearing with a modified hinged functional brace and return to school after an average of 32.5 days. At an average follow-up period of 2 years, no case has shown residual angulation or rotational deformities greater than 10 and 15 degrees. No shortening was demonstrated. Overgrowth of the fractured femur was common, with a maximum of 1.5 cm. No strong correlation between overgrowth and age, site, and type of fracture was found. Results were uniformly good for proximal, middle, and distal third fractures.

Modified Functional Bracing in the Ambulatory Treatment of Femoral Shaft Fractures in Children

Thirty children aged between 2 and 10 years with fractures of the femoral shaft were involved in a prospective study of a treatment method that requires a short period of traction followed by full weightbearing with a modified hinged functional brace and return to school after an average of 32.5 days. At an average follow-up period of 2 years, no case has shown residual angulation or rotational deformities greater than 10 and 15 degrees. No shortening was demonstrated. Overgrowth of the fractured femur was common, with a maximum of 1.5 cm. No strong correlation between overgrowth and age, site, and type of fracture was found. Results were uniformly good for proximal, middle, and distal third fractures.

Femoral shaft fractures in children: a prospective study of the overgrowth phenomenon

All children with fracture of the femoral shaft treated from August 1978 to December 1983 inclusive, comprised the study series. The object of the investigation was to determine whether a relationship could be demonstrated between shortening at the time of healing and the magnitude of overgrowth during the following 2 years. Radiographic measurements of both lower limbs were carried out at 6 weeks and 6, 12 and 24 months after the accident. During the period of the investigation 109 children suffered femoral fractures. Of these, 67 (61 per cent) met the criteria for inclusion in the study. The investigation could not demonstrate any relationship between shortening at the time of healing and the magnitude of overgrowth 2 years later. Neither was it possible to demonstrate any relationship between sex, age, type of fracture, level of fracture, and the magnitude of the overgrowth. The mean overgrowth was 10.8 mm and the largest 26 mm. Almost all children who healed with little shortening showed no angulation, and their average age was considerably below that of the series as a whole, while almost all femoral shaft fractures which healed with considerable shortening had some angulation and the average age of these children was much higher than that of the whole series. The importance of angulation in respect of shortening after femoral shaft fracture in children has not previously been reported.

A Clinical Study on the Treatment of Femoral Shaft Fractures in Children: Immediate Hip Spica Cast Immobilization

A Clinical Study on the Treatment of Femoral Shaft Fractures in Children: Immediate Hip Spica Cast Immobilization

Femoral nerve block for femoral shaft fractures in children: brief report.

Femoral nerve block for femoral shaft fractures in children: brief report.