Pediatric Femoral Shaft Fractures Research Articles

Does postoperative immobilization affect final alignment of pediatric femur fractures treated with flexible intramedullary nailing?

Flexible intramedullary nail (FIN) fixation of pediatric femur fractures is a popular method of fixation in children. Typical immobilization options include spica casting, long leg cast, knee immobilizers, or no immobilization and the decision to use each is usually left to surgeon preference. Our primary aim is to evaluate whether different postoperative immobilization status influences outcomes, namely radiographic alignment at the time of healing. A retrospective chart review was conducted of all patients with femur fractures treated with FIN fixation at a pediatric hospital from April 2018 through July 2022. Postoperative immobilization protocols were recorded and separated into two groups, patients who were immobilized (IMM) and patients who were not immobilized (NoIMM). Radiographs were evaluated for fracture alignment immediately following surgery and at the time of healing. Patients demographic, fracture, and postoperative clinical characteristics were compared between the two groups (NoIMM vs. IMM). A total of 41 patients were treated for diaphyseal femur fractures with FINs at our institution during the study period. No significant difference was observed in alignment at healing. Our results suggest that either immobilization or no immobilization after flexible intramedullary nailing of pediatric femoral shaft fractures are viable options when postoperative immobilization status is left to the surgeon's discretion.

Treatment of Pediatric Femoral Shaft Fractures by Using Plating Vs Flexible Nail Comparative Study

Treatment of Pediatric Femoral Shaft Fractures by Using Plating Vs Flexible Nail Comparative Study

Changes in femoral anteversion after intramedullary nailing for pediatric femoral shaft fracture: a multicenter study

BackgroundThe rotational change after using a flexible intramedullary (IM) nail for femoral shaft fractures has been a concern for many surgeons. Recently, a statistical shape model (SSM) was developed for the three-dimensional reconstruction of the femur from two-dimensional plain radiographs. In this study, we measured postoperative femoral anteversion (FAV) in patients diagnosed with femoral shaft fractures who were treated with flexible IM nails and investigated age-related changes in FAV using the SSM.MethodsThis study used radiographic data collected from six regional tertiary centers specializing in pediatric trauma in South Korea. Patients diagnosed with femoral shaft fractures between September 2002 and June 2020 and patients aged < 18 years with at least two anteroposterior (AP) and lateral (LAT) femur plain radiographs obtained at least three months apart were included. A linear mixed model (LMM) was used for statistical analysis.ResultsOverall, 72 patients were included in the study. The average patient age was 7.6 years and the average follow-up duration was 6.8 years. The average FAV of immediate postoperative images was 27.5 ± 11.5°. Out of 72 patients, 52 patients (72.2%) showed immediate postoperative FAV greater than 20°. The average FAV in patients with initial FAV > 20° was 32.74°, and the LMM showed that FAV decreased by 2.5° (p = 0.0001) with each 1-year increase from the time of initial trauma.ConclusionsThis study explored changes in FAV after femoral shaft fracture using a newly developed technology that allows 3D reconstruction from uncalibrated 2D images. There was a pattern of change on the rotation of the femur after initial fixation, with a 2.5° decrease of FAV per year.

Pediatric femoral shaft fractures: the American Academy of Orthopaedic Surgeons clinical practice guidelines versus actual management in a teaching hospital.

In 2009, the clinical practice guidelines (CPG) were released by the American Academy of Orthopaedic Surgeons (AAOS), which outline an age-based approach for treating pediatric femoral shaft fractures (PFSF), both nonoperatively and operatively. The aim of the current study was to investigate potential disparities between the recommended treatments for PFSF based on the AAOS-CPG and the actual treatments administered in The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University. A retrospective review was conducted on the medical charts and radiographs of all PFSF treated at The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2014 to January 2022. We identified 445 children who met our inclusion criteria and evaluated their treatments according to the AAOS-CPG. Actual treatments were then compared with the treatments recommended by the AAOS-CPG. Binomial and multivariate logistic regression was used to examine whether different factors could predict the choice between operative and nonoperative management. Operative treatments were undertaken in 102 of 215 (47.4%) fractures in children younger than 6 years, in 102 of 122 (83.6%) fractures in those between 6 and 12 years of age, and in 107 of 108 (99.1%) fractures in those older than 12 years. Nonoperative management was conducted in 113 of 215 (52.6%) fractures in children younger than 6 years, in 20 of 122 (16.4%) fractures in those between 6 and 12 years of age, and in 1 of 108 (0.9%) fractures in those older than 12 years of age. Surgeon decisions for non-surgery were in agreement with the CPG 52.6% of the time, whereas agreement reached 90.9% for surgical choices. Predictors of actual operative management were age (P=0.01), patient weight (P<0.001), fracture pattern (P<0.001), presence of other orthopedic injuries requiring surgery (P=0.002), and polytrauma (P=0.02). There was limited concordance between actual treatments and CPG recommendations, particularly for the nonoperative management of fractures in children under 6 years old. Age, patient weight, fracture pattern, presence of other orthopedic injuries requiring surgery, and polytrauma were the main predictors of our operative decision-making process.

Substantial rise in usage of elastic stable intramedullary nailing in treatment of unstable paediatric femoral shaft fractures by antegrade and retrograde methods: the real impact

Substantial rise in usage of elastic stable intramedullary nailing in treatment of unstable paediatric femoral shaft fractures by antegrade and retrograde methods: the real impact

Elastic Stable Intramedullary Nailing in Length Stable Versus Unstable Pediatric Femoral Shaft Fractures: A Comparison of Clinical, Radiographic, and Pedobarographic Outcomes.

Pediatric diaphyseal femoral fracture (PDFF) is one of the most common injuries requiring hospitalization. Elastic stable intramedullary nailing (ESIN) is commonly used for PDFFs in ages 5 to 11. The optimal treatment method for length unstable PDFF is a subject of ongoing debate. This study aimed to compare clinical, radiographic, and pedobarographic outcomes of ESIN between length stable and unstable PDFF. We retrospectively reviewed patients undergoing ESIN treatment for isolated PDFF between 2016 and 2021. Exclusion criteria were (1) history of ipsilateral or contralateral lower extremity fractures, (2) highly comminuted or segmental fractures, (3) body weight >50kg, and (4) comorbidities affecting bone quality, range of motion, or neurologic status. The patients were divided into 2 groups according to length stability. Clinical, radiographic, and pedobarographic data were then assessed to compare groups. Twenty-five patients were included (17 length stable and 8 length unstable PDFF) with a mean age of 73.6±17.8 months. There was no significant difference between groups in age, side of injury, body weight, follow-up duration, and nail-canal diameter ratio. Mean deformity in the fracture site in the early postoperative x-rays was not significantly different between groups ( P =0.661). After a mean follow-up of 27.8±14.2 months (range, 12-67), there was no significant difference in mechanical axis deviation, distal femur joint orientation angle, or limb-length discrepancy in both groups. The pedobarographic assessment revealed that the length unstable group had a significantly higher external foot progression angle in the injured extremity (9.8°±6.9° vs. 1.3°±5.6°, P =0.031). However, the length stable group had no significant difference in the foot progression angle (4.9°±5° vs. 3°±4.3°, P =0.326). There was no significant difference in either group for other pedobarographic parameters. ESIN is a safe and effective option for length-unstable PDFF, yet attention should be paid to the rotational alignment. Although significant external rotation deformity occurs in length-unstable PDFF, it has no implications for the other pedobarographic parameters. Level IV.

Outcome of Early Retrograde Closed Intramedullary Fixation of Fracture Shaft of Femur by Titanium Elastic Nail in Children

Background: Paediatric femoral shaft fractures are common in orthopaedic practice and can be managed using various modalities, each with its advantages and disadvantages. The Titanium Elastic Nailing System has emerged as a promising treatment option, offering potential advantages over traditional methods. Objective: This study aimed to evaluate the functional and radiological outcomes and operative complications of paediatric femoral shaft fractures treated with the Titanium Elastic Nailing System. Methods: A prospective interventional study was conducted from July 2020 to July 2021. Thirty children aged 6-14 years (mean age 11.32 ±3.76) were selected using purposive sampling and strict inclusion/exclusion criteria. Patients were followed up for at least 24 weeks at four-week intervals, and outcomes were assessed using Flynn's TEN scoring criteria. Results: All 30 patients completed the study. Radiological union was achieved in 80.0% of cases within 7-10 weeks, with 90.0% of patients able to bear full weight by the 12th week. Minor complications occurred in 20.0% of cases, while no major complications were reported. 80.0% of cases had excellent outcomes, 20.0% were satisfactory, and no poor outcomes were observed. Conclusion: The Titanium Elastic Nailing System is an excellent method for treating paediatric femoral shaft fractures, demonstrating high rates of radiological union and functional recovery with a low incidence of complications.

Comparative Outcomes of Elastic Stable Intramedullary Nailing vs. Plate Fixation in Pediatric Femoral Shaft Fractures. A Prospective Study.

Pediatric femoral fractures are common in emergency rooms, with treatment options varying by age. This study compares elastic stable intramedullary nailing (ESIN) and plate fixation for diaphyseal femoral fractures in children aged 5-10. Conducted at Al-Kindi Teaching Hospital, Baghdad, from December 2017 to December 2019, this prospective study included 32 children with closed transverse diaphyseal femoral fractures. Patients were divided into two groups: 16 treated with ESIN (Group 1) and 16 with plate fixation (Group 2). Criteria excluded comminuted, open, or pathological fractures. Group 1 had a mean age of 7.1 years and weight of 23.7 kg; Group 2 had a mean age of 7.8 years and weight of 30.9 kg. ESIN resulted in shorter operative times (58.4 minutes), earlier weight-bearing, and quicker fracture union (8.8 weeks) compared to plate fixation (76.3 minutes, 11.9 weeks). Blood loss was significantly less in Group 1 (32.8 ml) versus Group 2 (205.0 ml). No significant differences in wound healing or leg length discrepancies were observed. 1. Our study indicates a preference for Elastic Stable Intramedullary Nailing (ESIN) over plate fixation for pediatric femoral shaft fractures in children aged 5-10 years. 2. ESIN is associated with shorter operative times and faster commencement of weight-bearing, critical in pediatric recovery. 3. While ESIN is generally preferable, plate fixation may be better suited in certain clinical scenarios, emphasizing the importance of personalized treatment. 4. Based on our findings, ESIN is recommended for treating transverse diaphyseal femur fractures in the specified pediatric age group. 5. Recommends further studies, including randomized controlled trials, for a more comprehensive understanding of these treatments' long-term outcomes.

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.

Percutaneous TENS in Pediatric diaphyseal femoral fractures- Respects biology and ends happily

Femoral shaft fractures are amongst the most common major pediatric injuries treated by orthopaedic surgeons. They represent 1-2% of all fractures in the paediatric population. Paediatric males are affected more commonly than females. [1] There are various methods available for operative stabilization of paediatric femoral shaft fractures, which include external fixation, compression plating and rigid and flexible intramedullary nailing. [2] There is no uniform consensus on the treatment modality for femoral shaft fracture in school-aged children between 6 years to16 years. Titanium elastic nailing system (TENS) is a recent and widely used technique which allows stable reduction, maintenance of reduction and early mobilization. [3] American Academy of Orthopaedic Surgeons (AAOS) recommends with strong evidence based support in favour of the use of flexible intramedullary nailing for treating children age five to eleven years diagnosed with diaphyseal femur fractures. [4, 5] This device exploits a child’s denser bone, rapid healing and ability to remodel during period of bone growth. Here, we establish this axiom by a detailed case presentation, who was successfully treated with flexible intramedullary nailing for diaphyseal fracture of the femur.

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.

Outcomes in Early Versus Delayed Management of Pediatric Femoral Shaft Fractures.

There is a paucity of literature regarding the timing of treatment for pediatric femur fractures. The purpose of this study was to analyze whether early versus delayed management of pediatric femoral shaft fractures would impact outcomes regarding time to union and return to baseline function. Pediatric patients presenting with femoral shaft fractures, from January 1, 2010 to January 1, 2021, were identified using the Pediatric Trauma Database at a single Level One Trauma Center and retrospectively reviewed. Demographic information, surgical details, associated injuries, length of follow-up, time to union, and return to baseline function were collected. Patients were then divided into 2 groups; the early intervention group underwent treatment within 24 hours of admission versus the delayed group, which underwent treatment after 24 hours. Patients with neuromuscular disease, pathologic fracture, slipped capital femoral epiphysis, nonambulatory, younger than 6 months old, or had follow-up of <8 weeks posttreatment were excluded. χ 2 and unpaired Student t tests were used to compare outcomes. A P value ≤0.05 was used as the threshold of statistical significance. Of the 169 cases reviewed, 137 met the inclusion criteria. The mean age was 8.0 ± 5.0 (6mo to 16y). The average follow-up time was 1.4 ± 1.4 years. Thirty-two (19%) patients did not meet the inclusion criteria and were excluded from the study. One hundred twenty-two (89%) patients were in the early intervention group versus 15 (11%) in the delayed intervention group. There were no statistically significant differences between the early and the delayed arms in regard to time to union, quality of final reduction, and return to baseline function. The findings of this study support that the timing of surgical intervention of femoral shaft fractures in the pediatric population is not correlated to time to union and final function. Clinically, prompt treatment of pediatric femoral shaft fractures should not supersede medical methods of resuscitation and likely has no bearing on the final outcome. Level III.

Complications in operatively managed pediatric femoral shaft fractures

Objectives: Despite being the strongest long bone in the body, femur shaft fractures (FSFs) remain steadily prevalent in Saudi Arabia and globally. The goal of treatment is to achieve fracture healing with the least complications. Therefore, this study intended to determine the complications in pediatric FSFs, which were operatively managed. Methods: This study is a retrospective analysis of 76 pediatric FSFs. The inclusion criteria included age ≤14 years, FSFs operatively treated in the study center, at least one-year follow-up, and admission between January 1, 2012, and January 1, 2020. Pathological fractures and patients with neuromuscular or syndromic conditions were excluded from the study. Results: Seventy-two patients (81.9% boys, mean age 8.1 years) with 76 FSFs were analyzed. Most injuries were from motor vehicle accidents (41.6%), falls (29.1%), and pedestrian trauma (15.2%). Titanium was used in 47 (61.8%). Plating was used in 16 (21%), rigid nails in eight (10.5%), and hip spica under general anesthesia in five (6.5%). Out of those 76 fractures, 17 had developed complications. These complications varied in their significance, including limb length discrepancy (LLD) (five), non-union (three), 15° angulation (three), skin irritation due to cast soiling (two), skin swelling due to prominent flexible nail (one), surgical site infection (one), osteomyelitis (one). LLD was significantly associated with increased weight, fracture pattern, non-union, and definitive fixation time. Conclusion: Overall complications in operatively treated pediatric FSFs were low and not disabling. LLD was the most common with a significant association with increased weight, unstable fracture pattern, non-union, and definitive fixation time.

Paediatric femoral shaft fractures: an instructional review for the FRCS examination.

This review presents the principal features of paediatric femoral shaft fractures including the contemporary management strategies and relevant supporting evidence. The article is an overview of information relevant to clinical practice, in addition to preparation for the FRCS (Orth) examination.

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.

Elastic stable intramedullary nail fixation versus submuscular plate fixation of pediatric femur shaft fractures in school age patients: A PRISMA-compliant systematic review and meta-analysis.

Studies of clinical outcomes that compare the elastic stable intramedullary nail (ESIN) with the submuscular plate (SMP) were controversial. The meta-analysis was performed to summarize existing evidence, aiming to determine whether ESIN was superior to SMP in pediatric femur shaft fractures. Search strategies followed the recommendations of the Cochrane collaboration. Electronic searches such as PubMed, Embase, Web of Science, Cochrane were systematically searched for publications concerning ESIN and SMP from the inception date to March 2023. Two investigators independently searched, screened, and reviewed the full text of the article. Disagreements generated throughout the process were resolved by consensus, and if divergences remain, they were arbitrated by a third author. This study included 8 articles, comprising a total of 561 patients with a similar baseline. Compared to the SMP, the ESIN had shorter operation time (mean difference = -16.16; 95% CI = -22.83 to -9.48, P < .00001), and less intraoperative blood loss (mean difference = -53.62; 95% CI = -58.89 to -48.36, P < .00001), but had a higher incidence of implant irritation (odds ratio [OR] = 6.49; 95% CI = 3.01 to 13.98, P < .0001), lower limb malalignment (OR = 2.60; 95% CI = 1.12 to 6.04, P = .96) and overall complications(OR = 4.14; 95% CI = 2.51 to 6.84, P < .0001). And there was no significant difference in radiation time, length of hospital stay, limb length discrepancy, infection rate, delayed union rate and unplanned revised surgery rate (P > .05). Compared to the SMP, the ESIN offers shorter operative time, and less blood loss. However, the SMP is superior to ESINs in complication rates, especially regarding implant irritation and malalignment. Both methods could achieve excellent satisfactory functional outcomes. Thus, the SMP is an alternative choice in the pediatric femur shaft fracture.

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.

Comparing pediatric femoral shaft fracture repair patient outcomes between pediatric and non-pediatric orthopedic surgeons.

While pediatric femoral shaft fractures account for less than 2% of all fractures in children, they are the most common pediatric fracture requiring hospitalization. Management of pediatric femoral shaft fractures is challenging, with various treatment options relating to severity and patient age. The last few decades have seen an increased supply of pediatric orthopedic surgeons (POS) along with increased referral rates. However, there continues to be a maldistribution of POS throughout the country. This study sought to determine outcomes following femoral shaft fracture repair by POS compared to non-pediatric trained orthopedic surgeons. The National Surgical Quality Improvement Program-Pediatric database was queried to identify pediatric patients who underwent open treatment of femoral shaft fracture from 2012 to 2019. Differences in patient demographics, comorbidities, and postoperative complications were assessed and compared between patients who were treated by pediatric subspecialty-trained orthopedic surgeons and those treated by non-pediatric orthopedic surgeons. Bivariate and multivariable regression analyses were utilized. Of the 5862 pediatric patients who underwent femoral shaft fracture treatment, 4875 (83.2%) had their surgeries performed by a POS whereas 987 (16.8%) were operated on by a non-pediatric surgeon. POS were more likely to operate on patients with a higher American Society of Anesthesiologists classification (p < 0.001) and those with medical comorbidities, including gastrointestinal (p = 0.022) and neurological (p < 0.001). After controlling for baseline patient characteristics on multivariable regression analysis, patients treated by non-pediatric orthopaedic surgeons are at an increased risk of prolonged hospital stay (OR 2.595; p < 0.001) when compared to patients operated on by POS. The results indicated that patients undergoing surgical treatment for a femoral shaft fracture by a non-pediatric trained orthopedic surgeon were at increased risk of a prolonged hospital stay compared to those being treated by POS. Additionally, POS were more likely to operate on more difficult patients with increased comorbidities.

Comparative Study of Paediatric Femur Shaft Fracture Treated With TENS and DCP

Introduction: Paediatric femoral shaft fractures are common injuries in the age group treated by an orthopaedic surgeon. These fractures typically occur either in the early childhood when weak woven bone is changing to the stronger lamellar bone or at adolescence when children are subject to high energy trauma from motor vehicle accidents or from sports [1]. Femoral shaft fractures represent around 2.2% of all bony injuries in children. There are varieties of approaches to treat femoral fractures in the field of medical science. The aim of this study is to compare the outcomes between TENS and DCP approach for paediatric femur shaft fracture. Methodology: This was a prospective comparative study conducted at the department of Orthopaedics Surgery in Dhaka Orthopaedics Hospital, Dhaka, Bangladesh during December, 2017 to November, 2019. The ethical clearance of this study was obtained from the ethics committee of the hospital and a total of 23 children were enrolled in this study. The children were divided into two groups, TENS group n=14), DCP group (n=9). The collected data were analyzed using Statistical Package for Social Sciences (SPSS), software, version-23.0. Results: A total of 23 children aged 6-18 were enrolled in this study. Among the children 78 % were male and 22% were female. The mean age of the children was 10.7 years. In TENS group 9(63%) children fall from height and followed by 4(28%) got road traffic accident, and 1(7%) blunt trauma whereas in DCP group, 6(66%) fall from height and followed by 2(22%) got road traffic accident, and 1(11%) blunt trauma. In TENS group, 2(14%) children had radiologically comminuted fracture and followed by 3(21%) oblique, 9(63%) transverse whereas, in DCP group,1(11%) children had comminuted radiological fracture and followed by 2(22%) oblique and 6(66%) transverse In TENS group, the mean duration of surgery was 53.00 ±9.20 minutes while the mean duration of surgery in DCP group was 60.00±16.52 minutes, which was .....

Cast or Nail? Using a Preference-Based Tool for Shared Decision-Making in Pediatric Femoral Shaft Fracture Treatment.

Femoral shaft fractures are common injuries in children 2 to 7 years of age, with treatments ranging from casting to flexible intramedullary nails (FIN). Each treatment has unique attributes and outcomes are overall similar. Given equivalent outcomes, we hypothesized that a shared decision-making process, using adaptive conjoint analysis (ACA), can be used to assess individual family situations to determine ultimate treatment choice. An interactive survey incorporating an ACA exercise to elicit the preferences of individuals was created. Amazon Mechanical Turk was used to recruit survey respondents simulating the at-risk population. Basic demographic information and family characteristics were collected. Sawtooth Software was utilized to generate relative importance values of five treatment attributes and determine subjects' ultimate treatment choice. Student's t-test or Wilcoxon rank sum test was used to compare relative importance between groups. The final analysis included 186 subjects with 147 (79%) choosing casting as their ultimate treatment choice, while 39 (21%) chose FIN. Need for second surgery had the highest overall average relative importance (42.0), followed by a chance of serious complications (24.6), time away from school (12.9), effort required by caregivers (11.0), and return to activities (9.6). Most respondents (85%) indicated the generated relative importance of attributes aligned "very well or well" with their preferences. For those who chose casting instead of FIN, the need for secondary surgery (43.9 vs. 34.8, P <0.001) and the chance of serious complications (25.9 vs. 19.6, P <0.001) were the most important factors. In addition, returning to activities, the burden to caregivers, and time away from school were all significantly more important to those choosing surgery versus casting (12.6 vs. 8.7 P <0.001, 12.6 vs. 9.8 P =0.014, 16.6 vs. 11.7 P <0.001, respectively). Our decision-making tool accurately identified subjects' treatment preferences and appropriately aligned them with a treatment decision. Given the increased emphasis on shared decision-making in health care, this tool may have the potential to improve shared decision-making and family understanding, leading to improved satisfaction rates and overall outcomes. Level-III.