Femoral Fractures In Children Research Articles

Femoral Fractures in Children from 4 Years to 10 Years: Conservative Treatment

The journal highlights important recent developments from the world's leading clinical and research institutions. The journal publishes peer-reviewed papers on the diagnosis and treatment of pediatric orthopedic disorders. It is the official journal of IFPOS (International Federation of Paediatric Orthopaedic Societies).

Femoral Fractures in Children from 4 Years to 10 Years: Conservative Treatment

Femoral Fractures in Children from 4 Years to 10 Years: Conservative Treatment

Instabile kindliche Femur- und Unterarmschaftfrakturen - Vergleich zwischen konservativer Behandlung und stabiler intramedullärer Schienung -

Elastic intramedullary nailing represents a new surgical concept in the treatment of unstable shaft fractures in children. The present case control study wanted to examine the superiority of intramedullary nailing in comparison to conservative therapeutic concepts which had been applied so far. 13 children with forearm fractures who were treated initially by conservative measures were compared to 13 other children who received a primary intramedullary nailing. With femoral fractures, 12 children were included in each group. In each patient pair age, type and localisation of the fracture were comparable. During the observation period (until the termination of final therapeutic measures or until the third year after injury) we examined clinical variables and subjective findings. Both therapeutic concepts led to comparably good functional results. Also subjective judgement of the therapeutic success did not differ between groups. However, with intramedullary nailing of shaft fractures of the femur the mean hospital length of stay (7.0 +/- 3.5 days) was significantly shorter than with initial conservative treatment (36.5 +/- 2.2 days, P < 0.05). Irrespective of the localisation of the fracture intramedullary nailing required significantly less x-ray examinations during the observation period. These results suggest intramedullary nailing to be the procedure of choice to treat unstable forearm and femoral fractures in children.

Immediate hip spica casting for femur fractures in pediatric patients. A review of 175 patients.

Immediate closed reduction and application of a well-molded hip spica cast is a safe and effective treatment option for closed, isolated femur fractures in children who weigh between 10 and 100 pounds. Between 1988 and 1996, 190 immediate hip spica casts were placed on children with isolated femoral shaft fractures who weight between 10 and 100 pounds. Fifteen patients were lost to followup leaving 175 children who were evaluated and followed up for at least 2 years after the hip spica cast was removed (range 2-10 years). The femur fractures were reduced closed and placed in a 1 1/2 hip spica cast in the emergency room with the patient under conscious sedation or in the operating room with the patient under general anesthesia. All of the children returned home within 24 hours of the procedure. All 175 femur fractures united within 8 weeks. The only complication was a refracture in a 25 pound child who fell 1 week after the cast was removed. No significant residual angular deformities were present in any of the children at last followup. None of the children required external shoe lifts, epiphysiodesis, antibiotics, irrigation and debridements, or limb lengthening procedures for leg length inequalities. The authors think that immediate closed reduction and placement of a well-molded hip spica cast is a safe and reliable treatment option for isolated, closed femur fractures in children from birth to 10 years of age who weigh less than 80 pounds.

Ender rod fixation of femoral shaft fractures in children.

Ender rod fixation for femoral shaft fractures in children was evaluated in a prospective study at two Level 1 trauma centers. Fifty-seven fractures in 52 patients were evaluated. Criteria for inclusion in the study included age younger than 14 years, femoral shaft fractures occurring in the middle 3/5, canal size greater than 7 mm, and parental consent. Hip and knee motion, gait, leg length discrepancy, and rotational asymmetry were evaluated by clinical examination. Standard radiographs were used to measure any residual angulation. A subset of patients whose injuries occurred more than 12 months previously was evaluated using scanograms. Followup averaged 20 months. There were no delayed unions and all fractures healed within 12 weeks. Clinically significant leg length discrepancy, malunion, or loss of motion did not occur. Functional results were excellent and complications were minor. Ender rod fixation of femur fractures in children allows the advantages of surgical fixation with minimal risk of complications.

Open Femur Fractures in Children: Treatment, Complications, and Results

Open Femur Fractures in Children: Treatment, Complications, and Results

Open femur fractures in children: treatment, complications, and results.

We evaluated retrospectively the treatment of 44 open femur fractures occurring between the lesser trochanter and the distal femoral physis in 43 children aged 16 years and younger. Fractures that involved the physis or that were a consequence of gunshot wounds were excluded. There were 25 grade I, 9 grade II, and 9 grade III fractures. The mean age at injury was 9.5 years. Ninety percent of the fractures were automobile related. More than 70% of the children had associated injuries. The average time to healing for all fractures in this study was 17 weeks. Our data indicate that there is a statistically significant increased time to heal with increasing age of the child (p = 0.04). Additionally, grade III fractures healed more slowly than grade I or II fractures (p = 0.0006). Fractures treated with external fixation took longer to unite than those treated with other methods (p = 0.05). The presence of complications increased the time to fracture union (p = 0.00001). Grade III injuries were the most difficult to manage; 50% of the fractures in this group developed osteomyelitis and 20% malunited. In contrast, none of the fractures in either the grade I or II groups developed deep infection. After aggressive debridement, grade I and grade II fractures may be stabilized with age-appropriate fixation methods. Grade III injuries should be managed with vigorous debridement and vigilance, as these injuries are prone to deep infection and malunion. The optimal method of skeletal stabilization in grade III fractures remains unresolved.

Elastic stable intramedullary nailing for unstable femoral fractures in children: preliminary results of a new method.

Many femoral fracture patterns in children cannot be stabilized sufficiently by intramedullary nailing only. Such fractures may require additional cast bracing or cerclage wiring after nailing. To overcome this problem, pediatric Ender nails that can be interlocked were designed to achieve better fracture stabilization. Seventeen children (age, 2.5 to 15 years) were treated with this method for unstable traumatic fractures of the femur. The average follow-up period was 11.8 months. All fractures healed within 4 weeks in the mean. There were no major complications. This new method prevents shortening and axial deviation of the fractured femur. Start of postoperative mobilization and increase of weight-bearing is mainly determined by the child.

Femur fractures in children: treatment with early sitting spica casting.

The purpose of this article is to review our experience with early spica casting and determine risk factors for loss of reduction and skin complications. The radiographic and clinical charts of 114 children were retrospectively reviewed. At the time of fracture union, excessive shortening and angular malunion were not significant problems. Loss of reduction and skin complications occurred in 20 and 14% of patients, respectively. In addition to previously described risk factors, we identified spica knee flexion angle < 50 degrees as predictive of eventual loss of reduction and found that > 2 cm of initial shortening was not a contraindication to early spica casting. Factors associated with skin problems included younger age and abuse as a mechanism of injury. In our opinion, early spica casting is the treatment of choice for all isolated, closed femur fractures in otherwise healthy children aged 6 years or younger, regardless of the degree of initial deformity.

Femur Fractures in Children: Treatment with Early Sitting Spica Casting

Femur Fractures in Children: Treatment with Early Sitting Spica Casting

Ender nails: an alternative for intramedullary fixation of femoral shaft fractures in children and adolescents.

Fixation of femur fractures in children and adolescents is becoming widely accepted because of the lower chance of iatrogenic infection and prohibitive cost of in-hospital traction and spica cast care. Interlocking nails, which have dramatically improved adult femur fracture care, have posed problems, such as injury to the greater trochanteric apophysis and osteonecrosis of the femoral head. We reviewed a series of five stable femoral shaft fractures treated with Ender nails in children from 9 to 17 years of age. No serious complications (eg, leg length inequality) occurred. Follow-up averaged more than 3 years. Complete healing, with return to preinjury activity levels, occurred within 11 weeks on average. Decreased hospitalization, low cost of implants, less potential damage to growth centers, and decreased blood loss and operative time suggest this procedure has merit. Attention to operative technique diminishes previously reported complications attributed to Ender nails.

Conservative Treatment of Femoral Fractures in Children

Conservative Treatment of Femoral Fractures in Children

The Use of External Fixators in Femur Fractures in Children

The Use of External Fixators in Femur Fractures in Children

The use of external fixators in femur fractures in children.

Between 1988 and 1993, 81 children with 82 femur fractures were treated with external fixators at the Santobono Children's Hospital of Naples. This technique was reserved for children older than 6 years with open fractures, multiple fractures, multiple trauma, and unstable fractures. The patients were placed in skin traction on admission, and after 24-48 h, the external fixator was applied under general anesthesia. Therefore, within 1 week the children were able to take care of themselves and to attend school. The fixator was very well tolerated and was removed 8-9 weeks later. The fractures healed with good alignment, no complications with few cases of superficial infections, and less overgrowth. The use of external fixation is recommended for its simplicity and lack of complications.

Devenir à l'âge adulte de 50 fractures du fémur, opérées chez l'enfant, entre 3 et 13 ans

After a rewiew of the history of surgical treatment of femoral fractures in children, the author studies 50 cases (37 nailed and 13 plated) followed up to adulthood.

Fractures in children.

The literature published in the past year on fractures in children has helped us to increase our understanding of the natural history of fracture healing in children and introduced new techniques for fracture treatment. There is an impetus for operative fixation of femur fractures in children. The possibility is raised of growth derangement as a result of intramedullary nailing. Supracondylar fractures of the elbow continue to be a frequent topic for discussion. The benefits of adequate reduction and internal fixation have been reinforced. The incidence of nerve palsy, especially that of the anterior interosseous nerve, has been emphasized. New radiographic parameters for determining intraoperative reduction have been described. The management of radial neck fracture has been improved with percutaneous reduction proposed as an alternative to complication-fraught open reduction. New information has been brought to the forefront regarding knee injuries, in particular the implications of hemarthrosis and tibial eminence fractures. Biodegradable implants have become important as they prove to be useful in children's fracture management. Such implants have been shown to be useful in fractures that do not require rigid fixation. However, biodegradable devices may be associated with foreign body reactions.

Treatment Femoral Fracture in Children

Treatment Femoral Fracture in Children

Post-traumatic length discrepancy and muscular atrophy after femoral fractures in childhood

The results of a clinical follow-up study of 107 children treated in the University Hospital Hamburg-Eppendorf because of femoral shaft fractures are shown. Most of the fractures healed with lengthening of the fractured bone and showed a muscles atrophy of the concerned limb as well. This study demonstrates the connections between these alterations.

Rotational remodeling of malrotated femoral fractures: a model in the rabbit.

It is estimated that 20-40% of femoral fractures in children heal in malrotation, yet few patients later complain. To determine if malrotation corrects spontaneously, midshaft osteotomies were made in femurs of 16 rabbits aged 8 weeks and the distal fragments were internally rotated 45 degrees, where they were held with external fixators. The animals were killed between week 0 and week 17. Version of the femoral necks was determined by computed tomography scan (CT). The version altered rapidly toward normal from weeks 0 to 4 and then remained stable, with an average rotational remodeling of 55%.

External fixation of femur fractures in children.

Forty-two children (44 femur fractures) were treated by primary external fixation and early weightbearing (1984-1989). The fractures were reduced anatomically when possible. Average age at fracture was 9 years 7 months (range, 2 years 5 months to 17 years 8 months). Duration of external fixation averaged 70 days (range 42-117 days). Of 176 pins, 15 (8.5%) were inflamed and five (2.8%) required intravenous antibiotics; none resulted in osteomyelitis. Most patients returned to school by 4 weeks, and all had full knee motion 6 weeks after fixator removal. Of 16 patients with documented follow-up of at least 18 months, only six (38%) had overgrowth from 2 to 10 mm (average 5.8 mm).