Pediatric Femoral Shaft Fractures Research Articles

Retrograde Intramedullary Nailing of Pediatric Femoral Shaft Fractures Does Not Result in Growth Arrest at the Distal Femoral Physis-A Retrospective Cases Series.

To evaluate femoral growth after placement of retrograde intramedullary nails in the treatment of pediatric femoral shaft fractures. Retrospective case series. Large urban trauma center in Mongolia. Twenty-nine pediatric patients who sustained a diaphyseal femoral shaft fracture were included in the study. Retrograde intramedullary nail fixation with the standard, fin, or pediatric fin Surgical Implant Generation Network nail across an open distal femoral physis. The main outcome measure was the distance traveled by the intramedullary nail with respect to the distal femoral condyles and distal femoral physis from initial surgery to follow-up. The mean age of patients was 10.7 years (range: 7-14 years). Follow-up occurred at a mean of 292 days (range: 53-714 days). Both condyle distance and physis distance were significantly positively correlated with follow-up days, with Pearson R values of 0.90 (P < 0.001) and 0.84 (P < 0.001), respectively. Multiple regression analysis revealed that follow-up days was the only significant predictor of physis distance, whereas age, sex, percent growth plate violation, and nail fully traversing physis were not significant predictors. The nail completely crossed the physis in 5 patients and no growth arrests were found. This is the first study, to our knowledge, to evaluate treating femoral shaft fractures with a retrograde nail across an open distal femoral physis. In the pediatric population, the use of a retrograde femoral intramedullary nails does not seem to cause growth arrest of the injured femur during the postoperative period and may be a reasonable treatment option when other surgical options are not available. Additional study is necessary to further evaluate the safety profile. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Clinical and functional outcomes of Paediatric femoral shaft fractures managed non-operatively at Nkhotakota District Hospital, Malawi.

Femoral shaft fracture is a common paediatric injury, managed non-operatively with skin traction in Malawian public hospitals. The clinical and functional outcomes of this treatment modality are unknown in Malawi. We retrospectively identified all children who were managed at Nkhotakota District Hospital with skin traction after sustaining closed femoral shaft fractures from January 1, 2013 to December 31, 2016. We collected demographic characteristics and treatment history from the patient's inpatient medical records, then invited each patient to undergo in-person follow-up clinical and functional assessment. We identified 149 patients. Gallows traction 26 (17%) and 123 Bucks skin traction (83%). The mean age for Gallows traction was 10 months (95% CI: 8-11), most were males (16, 62%). Fall was the most common cause of injury (19, 73%), and mean hospitalization of 15.8 days (95% CI: 13.8-17.9). Eighteen patients (69%) were followed up at a mean of 4.2 years after discharge, all were full weight bearing, had achieved radiographic fracture union, and had no functional limitations or pain during regular activity. Buck's skin traction mean age was 5.2 years (95% CI: 4.7-5.8), most were males (82, 67%), and fall (85, 69%). We followed up 83 patients (67%) at a mean of 4.1 years after hospital discharge, all of whom had achieved radiographic fracture union. All but one patient were full weight bearing and had normal gait. At follow-up, 14 patients (17%) reported some level of pain, 5 patients reported that their injury limited their return to household chores, and 2 reported that their injury also limited their return to school. Despite the limitations of this study, non-operative management of paediatric femoral shaft fractures at Nkhotakota District Hospital may have good clinical and functional outcomes and minimal complications. A future prospective study may be helpful to confirm these findings.

The Bisaccia and Meccariello technique in pediatric femoral shaft fractures with intramedullary titanium nail osteosynthesis linked external-fixator (IOLE): validity and reliability.

Background:Over the last 20 years, the incidence of pediatric femoral shaft fractures was increased, due to changes in the children’s daily activities. The healing times are different according to the chosen treatment and to other factors such as age, type of fracture, the involvement of the soft tissues, and concomitance with other injuries. The Bisaccia and Meccariello technique (Intramedullary titanium nail Osteosynthesis Linked External-fixator -IOLE) was born to prevent rotationally and lengthening malunion or nonunion in the treatment of pediatric femoral shaft fractures.Hypotheis:The aim or the objective of this paper is to compare the IOLE with the two most used methods for the treatment of femoral fractures in children.Methods:From 2000 to 2016, 58 pediatric patients with femoral shaft fractures were surgically treated and enrolled in the study. The ranged age of the patients was between 3 and 15 years. Twenty-two patients were treated with endomedullary titanium nails (TEN), 22 with external axial or modular external fixators and 14 patients treated with IOLE technique. The IOLE technique, in brief, is the hybridization of titanium intramedullary nails with a modular external fixator. It is divided into three phases, the first revenue given the length of the femur with the external fixator; the second, the rotations are dominated by the elastic nails; and the third finally they are hybridized on the external fixator. Comparing the three groups, radiographic images were taken to assess fracture reduction and consolidation.Results:At the final follow-up, statistically significant differences in not weight-bearing times were found in favor of the IOLE group. There were no statistical differences between three groups in terms of significant rotation defects, angulation, growth, and/or nonunion.Conclusions:The Bisaccia- Meccariello technique (IOLE) showed to lead to healing the pediatric femoral shaft fracture of the femur but allows an early weight-bearing to these patients and normal life like that.

Traitement des fractures de la diaphyse fémorale de l’enfant comparant embrochage élastique stable versus fixateur externe : méta-analyse

BackgroundThere is currently a debate about whether elastic stable intramedullary nails (ESIN) or external fixation (EF) is the best surgical method for treating pediatric femoral shaft fractures. We performed a meta-analysis to determine which surgical method leads to higher treatment satisfaction, lower complication rates, and reduced treatment time, to investigate whether ESIN is the preferred surgical method for treatment of pediatric femoral shaft fractures. Patients and methodsRelevant databases were searched for comparative studies of ESIN versus EF for the treating pediatric femoral shaft fractures. Literature reports and quality evaluations were extracted, followed by a systematic review using RevMan 5.3 software. Treatment satisfaction at the last follow-up, primary complications, secondary complications, and relevant time indicators (operation time, hospital stay, clinical healing time, bone healing time) were analyzed. ResultsA total of 22 reports were included in this meta-analysis. We found no statistical differences in the treatment satisfaction at the last follow-up between ESIN and EF for the treatment of pediatric femoral shaft fractures. A low rate of post-operative re-fracture (RR=3.58, 95% CI [1.85, 6.92], p=0.0001) and postoperative infection (RR=9.25, 95% CI [5.32, 16.11], p<0.00001), and a high risk of skin irritation (RR=0.15, 95% CI [0.06, 0.37], p<0.00001) were found in the ESIN group. No significant differences between the two approaches were found regarding malunion. A low rate of limb-length discrepancy (RR=2.41, 95% CI [1.40, 4.17], p=0.002), hospitalization (SMD=0.84, 95% CI [0.24, 1.43], p=0.006), clinical healing time (SMD=0.95, 95% CI [0.56, 1.33], p<0.00001) and bone healing time (SMD=0.89, 95% CI [0.39, 1.40], p=0.005) were found in the ESIN group, as compared to that in the EF group. No significant differences were found in fixation failure, activity limitation of the joint, and operation time between the two strategies. DiscussionESIN should be the primary choice for the treatment of pediatric femoral shaft fractures since it has a reliable curative effect and results in a shorter hospital stay, faster fracture healing, and fewer complications. EF is recommended for fractures with serious injury of the soft tissue to avoid intramedullary infection. Double-blind high-quality randomized studies with larger sample sizes are warranted to confirm our conclusions. Level of evidenceIV.

Treatment of pediatric femoral shaft fractures with elastic stable intramedullary nails versus external fixation: A meta-analysis

BackgroundThere is currently a debate about whether elastic stable intramedullary nails (ESIN) or external fixation (EF) is the best surgical method for treating pediatric femoral shaft fractures. We performed a meta-analysis to determine which surgical method leads to higher treatment satisfaction, lower complication rates, and reduced treatment time, to investigate whether ESIN is the preferred surgical method for treatment of pediatric femoral shaft fractures. Patients and methodsRelevant databases were searched for comparative studies of ESIN versus EF for the treating pediatric femoral shaft fractures. Literature reports and quality evaluations were extracted, followed by a systematic review using RevMan 5.3 software. Treatment satisfaction at the last follow-up, primary complications, secondary complications, and relevant time indicators (operation time, hospital stay, clinical healing time, bone healing time) were analyzed. ResultsA total of 22 reports were included in this meta-analysis. We found no statistical differences in the treatment satisfaction at the last follow-up between ESIN and EF for the treatment of pediatric femoral shaft fractures. A low rate of postoperative re-fracture (RR=3.58, 95% CI (1.85, 6.92), p=0.0001) and postoperative infection (RR=9.25, 95% CI (5.32, 16.11), p<0.00001), and a high risk of skin irritation (RR=0.15, 95% CI (0.06, 0.37), p<0.00001) were found in the ESIN group. No significant differences between the two approaches were found regarding malunion. A low rate of limb-length discrepancy (RR=2.41, 95% CI (1.40, 4.17), p=0.002), hospitalization (SMD=0.84, 95% CI (0.24, 1.43), p=0.006), clinical healing time (SMD=0.95, 95% CI (0.56, 1.33), p<0.00001) and bone healing time (SMD=0.89, 95% CI (0.39, 1.40), p=0.005) were found in the ESIN group, as compared to that in the EF group. No significant differences were found in fixation failure, activity limitation of the joint, and operation time between the two strategies. DiscussionESIN should be the primary choice for the treatment of pediatric femoral shaft fractures since it has a reliable curative effect and results in a shorter hospital stay, faster fracture healing, and fewer complications. EF is recommended for fractures with serious injury of the soft tissue to avoid intramedullary infection. Double-blind high-quality randomized studies with larger sample sizes are warranted to confirm our conclusions. Level of evidenceIV.

"Unstable" Pediatric Femoral Shaft Fractures Treated With Flexible Elastic Nails Have Few Complications.

To determine our complication rate in pediatric femoral shaft fractures treated with flexible elastic nailing and to determine fracture characteristics that may predict complications. Retrospective cohort study. One Level 1 and One Level 2 academic trauma centers. One hundred one pediatric femoral shaft fractures treated from 2006 to 2018. Major and minor complications. One hundred one femurs met inclusion criteria. The average age was 7 years (range 3-12 years). The average weight was 29.0 kg (range 16-55 kg). The average follow-up was 11 months (6-36 months). Ninety-three patients underwent elective implant removal at our institution. Fifty-one of the 101 (50%) fractures were "unstable" patterns. Ninety-three percent had implants that filled >80% of the canal (69 titanium and 32 stainless steel). Seventeen percent (18) had cast immobilization. All fractures went on to union. No patient required revision surgery for malunion as follows: 6 had coronal/sagittal malalignment >10 degrees, 3 had malrotation >15 degrees, and none had a leg length inequality >1 cm. Three patients had an unplanned surgery as follows: 2 for prominent implants and 1 for refracture after a second injury. There were no patient, fracture, or treatment characteristics that were predictive of complications or unplanned surgery, including "unstable" fractures (P = 0.78). Our study demonstrates that flexible elastic nailing can be safely used in most pediatric femoral shaft fractures, including those previously described as "unstable." Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Pediatric Femoral Shaft Fracture: An Age-Based Treatment Algorithm.

Fractures of the femoral shaft in children are common. The rates of bone growth and remodeling in children vary according to their ages, which affect their respective management. This paper evaluates the incidence and patterns of pediatric femoral shaft fracture and the current concepts of treatments available. The type of fracture-closed or open; stable or unstable-needs to be taken into account. Child abuse should be suspected in fractures sustained by infants. For younger children, non-surgical management is preferred, which include Pavlik harness (< 6 months old) and early spica casting (6 months to 6 years old). Older children (> 6 years old) usually benefit from surgical treatments as outcomes of non-surgical alternatives are worse and are associated with prolonged recovery times. These operative measures for older children that are 6-12 years old include elastic stable intramedullary nailing and submuscular plating. Factors to be considered when devising an appropriate intervention include body mass, location of injury, and nature of fracture. For adolescent and skeletally mature teenagers (> 12 years old), rigid antegrade entry intramedullary fixation is indicated. In the event of open fractures or polytrauma, external fixation should be considered as a temporary treatment method for initial fracture stabilization. An age-based and evidence-based algorithm has been proposed to guide surgeons in the process of evaluating an appropriate treatment.

Fracture characteristics predict suboptimal alignment in preschool femoral shaft fractures treated with spica casting: a retrospective chart review

Background: The authors aimed to identify the incidence of suboptimal alignment in preschool-aged children with diaphyseal femoral fractures treated with closed reduction and spica casting. We also sought to identify possible risk factors leading to suboptimal final alignment and the number of children initially treated by spica casting who needed revision surgery. Methods: This study retrospectively reviewed 132 cases of pediatric (age 3 to 6 yr) femoral shaft fractures treated with closed reduction and spica casting between January 2005 and October 2016. We evaluated whether age, weight, sex, mechanism of injury, fracture pattern, location, shortening, and angulation led to either acceptable or suboptimal fracture alignment at final radiographic follow-up. Results: Eighty-five patients (64.4%) healed in acceptable alignment, and 47 (35.6%) healed in unacceptable alignment. Higher energy injury patterns (transverse and comminuted) were more likely to result in suboptimal alignment at healing than lower energy patterns (oblique and spiral) (P=0.049). Proximal fractures trended towards more unfavorable results than other sites (P=0.068). Three independent risk factors for suboptimal alignment were identified including higher energy injury, initial coronal angulation greater than 8 degrees, and proximal fracture location. We determined a 99% chance of unacceptable alignment with three risk factors. We had a 9.8% (13 of 132 patients) return to operating room rate including 11patients for loss of reduction and two for cast soiling. Conclusions: Certain preschool-aged children with femoral fractures are at higher risk for suboptimal alignment after spica cast treatment. In higher risk cases, it may be reasonable to consider operative intervention and early mobilization instead of closed reduction and spica casting. Level of Evidence: Level IV.

Titanium Elastic Nails are a Safe and Effective Treatment for Length Unstable Pediatric Femur Fractures

Background: Controversy exists regarding the treatment of length unstable pediatric femoral shaft fractures. The purpose of this study was to investigate the outcomes of skeletally immature children with length unstable femur fractures treated with titanium elastic nails (TEN). Methods: Retrospective review was conducted on all patients with femoral shaft fractures at a tertiary care pediatric hospital from April 2006 to January 2018. Patients with femoral shaft fractures treated with TEN and minimum 6 months follow-up were included. Exclusion criteria were age > 11 years, weight > …

Flexible Intramedullary Nails are an Effective Treatment for Femoral Shaft Fractures in Children with Non-Ambulatory Neuromuscular Disorders but Carry Increased Risk of Early Revision Surgery and Angular Deformities

Background: There are no reports in the literature on flexible intramedullary nails (FIN) for the treatment of pediatric femoral shaft fractures in children with neuromuscular disorders. The purpose of this study is to investigate the outcomes of FIN for femoral shaft fractures in children with neuromuscular disorders. We hypothesized that FIN would yield favorable outcomes despite technical challenges in this population. Methods: Retrospective review was conducted on all patients with femoral shaft fractures at a tertiary care pediatric hospital from 2004-2018. Inclusion criteria were femoral shaft fracture treated with …

Effect of titanium elastic nailing surgery on the femoral development in pediatric femoral fractures

Purpose: The aim of this current study was to investigate the effect of titanium elastic nailing surgery following the pediatric femoral shaft fractures on the long-term pediatric femoral development.Materials and Methods: Thirty-five patients with a mean age of 62.1 months(15-160) who underwent surgery with titanium elastic nailing following unilateral femoral shaft fracture in our clinic were included in this study..At the last postoperative visit, patients were further evaluated through the physical examination and comparative femoral anterior posterior and lateral radiographs.The difference in length of the lower extremities and deformities in the frontal and sagittal plane, collodiaphyseal angle, mechanical distal femoral lateral angles were all calculated and compared with the intact femoral length and angles. Results: The mean follow-up period in our study was 69.8 months (36-120).The mean fracture union time period was 11.2 weeks(8-13).The mean implant removal time was 5.1months(2-12).At the last follow-up, 1 patient(2.8%) had 5mm shortening in the femur lenght while 3 patients’ femurs(8.5%) got longer with the average of 6 ± 4mm compared to that of the intact femur. In 8 patients (22.8%), varus angulation was measured as 4.7°± 2.1 at the fracture line. Conclusion: The treatment of femoral shaft fractures with titanium elastic nailing surgery has a limited effect on pediatric femur development in the long term. Surgical treatment of pediatric femoral fractures with titanium elastic nailing is a simple and safe method of treatment with low long-term complications.

A comparative study of the management of pediatric femoral shaft fractures treated conservatively with traction or spica casting

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Femoral shaft fractures, though not very common, are of major concern for orthopedic surgeons. the management for infants and older children is generally universal but the young patients still offer a management dilemma.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We present a prospective study conducted at a tertiary care hospital in India of 37 children between 1 year and 6 years to compare the two conservative methods most commonly used i.e. spica casting and traction application.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; We found that though both the methods are similar in the time for union, shortening was better controlled with traction and angulation with spica casting. The frequency of other complications was also comparable.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Both the methods give acceptable results and given the feasibility of such procedures in developing countries, both may be recommended. However, the choice thus depends on the surgeon treating the patient keeping in mind the drawbacks and limitations of each.&lt;/p&gt;

FUNCTIONAL OUTCOME OF FRACTURE SHAFT OF FEMUR IN PEDIATRIC AGE GROUP TREATED WITH TITANIUM ELASTIC NAILING SYSTEM

Femoral shaft fractures are common fractures in paediatric age group. In children, fractures of the femoral shaft have been traditionally treated mostly by conservatively immobilization in a Spica cast, either immediately or after a period of traction. But this safe form of treatment has major drawbacks. The management of paediatric femoral shaft fractures gradually has evolved towards a more operative approach in the past decade. Elastic stable intramedullary nailing (ESIN) or Titanium elastic nailing system (TENS) is a recent technique which allows stable reduction, maintenance of reduction and early mobilization. . Aim of study is to assess the functional outcome of fracture shaft of femur in pediatric age group treated with titanium elastic nailing system. It is a prospective study which was conducted in the all children between 5-14 years of age with diaphyseal fractures of femur. Outcome of fracture shaft of femur in pediatric age group treated with titanium elastic nailing system was studied studied by observing following, Type of reduction among children with diaphyseal fractures of femur, .Duration for union after surgery , Range of motion after surger, weeks of Weight Bearing started , Limb length discrepancy, Malalignment . From present study we conclude that femur diaphyseal fracture in children between 5-14 years of age can be effectively managed with titanium elastic nails. TENS offers a biological, minimally invasive method of treatment for fracture shaft of femur in children with advantages of sufficient axial stability, early mobilization and more rapid return to function. this technique yields higher rate of excellent functional outcome.&#x0D; Keywords: Femur, Diaphyseal Fracture, Children, TENS

Predictors of Open Reduction in Pediatric Femur Fractures Treated With Flexible Nails

Closed reduction (CR) is sufficient to reduce the majority of femur fractures treated with flexible intramedullary nailing (FIN). No previous study has examined factors associated with failed CR of pediatric femoral shaft fractures treated with FIN. We sought to determine preoperative factors associated with failed CR. We hypothesized that fracture, patient, and surgeon characteristics would impact the need for open reduction (OR). A retrospective review of children treated for femur fracture between 2012 and 2017 at a tertiary pediatric hospital was performed. Comparisons were made between 2 groups: FIN with CR group and FIN that required OR group. Demographic and baseline characteristics were compared between treatment groups using either χ tests or Fisher exact tests for categorical variables and general linear models for continuous variables. Odds ratios with 95% confidence intervals were calculated using univariate logistic regression tests. Of 449 consecutive pediatric femur fractures treated at our center, 85 children were treated with FIN and constituted the study cohort. CR failed in 14 patients (16.5%) necessitating OR of the fracture site. Significant differences between study groups were found in fracture location (P=0.018), the mechanism (P=0.003), and displacement on the anteroposterior radiograph (P=0.027). Surgical time was found to be longer in the OR group (P=0.010). We identified 3 preoperative predictors of OR for FIN including fractures caused by high energy mechanisms (odds ratio=7.5), distal third fractures (odds ratio=15.3), and fracture displacement on the anteroposterior view (odds ratio=1.06). Surgeon years in practice, patient weight, age, and time from injury to surgery were not associated with OR. This study presents 3 preoperative risk factors that predict the need for OR of femur fractures treated with FIN. Surgical time was longer in cases that required OR. Our findings suggest that surgeons should avoid lengthy attempts at CR and consider a lower threshold for OR of at-risk fractures or use another technique other than flexible nails. Level III-prognostic.

Isolated femoral shaft fractures in children rarely require a blood transfusion

BackgroundNo recent study has examined how a trend toward surgical fixation for pediatric femoral shaft fractures has impacted blood loss and transfusion requirements. The purpose of this study was to determine the factors influencing transfusions in the treatment of pediatric femoral shaft fractures. MethodsA retrospective review of patients with femoral shaft fractures treated surgically from 2004 – 2017 at a tertiary pediatric hospital was conducted. Electronic medical records were reviewed for fixation method, additional injuries, blood loss (estimated blood loss (EBL), hemoglobin, hematocrit) and transfusion. The relationship between fixation method with blood loss and transfusion was examined. Two groups were compared, those with and without additional injuries. Additional injuries were defined as additional fractures and/or abdominal, chest, or head injuries. Results172 patients met inclusion criteria. There were 129 patients with isolated femoral shaft fractures and 43 patients with femoral shaft fractures and concomitant additional injuries. The transfusion rate in patients with isolated femoral shaft fractures was 0.8% (1/129) which was significantly lower than in patients with additional injuries; 39.5% (17/43) (p < 0.05). In patients with additional injuries, there was a significant relationship between number of additional surgeries and odds of transfusion (OR=2.1, CI: 1.2–3.6, p < 0.05). In patients with isolated femoral shaft fractures, EBL was higher in patients treated with rigid intramedullary nails (148.5 ± 119.0 mL) than flexible intramedullary nails (34.1 ± 56.3 mL) (p < 0.05). However, there was no significant difference in transfusion or changes in hemoglobin/hematocrit between fixation methods in patients with isolated femoral shaft fractures. ConclusionPediatric patients with surgically treated isolated femoral shaft fractures rarely require transfusion (<1%), while patients with femoral shaft fractures and additional injuries had a high transfusion rate (39.5%). Surgical fixation method had a significant impact on EBL, with rigid intramedullary nail fixation having a significantly higher EBL than flexible intramedullary nails, however it did not lead to higher rates of transfusions. Blood transfusions are rarely needed in isolated femoral shaft fractures, despite the trend towards increase in surgical fixation and newer fixation techniques.

Short-term outcomes of submuscular bridge plating of length-unstable paediatric femoral shaft fractures in children - Insights from a South African tertiary hospital setting

ABSTRACT BACKGROUND: Femoral diaphyseal fracture is a common paediatric orthopaedic injury; however, the management of these fractures remains controversial in children between the ages of 6 and 13 years. The preferred approach for children appears to be surgical, enabling early mobilisation. Some studies have reported that submuscular bridge plating (SBP) might be a good alternative treatment method with favourable outcomes. The aim of this study was to determine whether SBP a) leads to union in length-unstable fractures with a low complication rate; b) leads to reasonable alignment and leg length equality; and c) has acceptable clinical outcomes in a South African tertiary hospital setting. METHODS: All patients with predominantly length-unstable femoral diaphyseal fractures who were treated between 1 January 2011 and 31 December 2012 were included in this study. Patients were treated with SBP using standard of care techniques, and hardware removal was performed at approximately eight months post-operatively. The nine months post-operative assessment between the affected and unaffected leg was used to assess the effectiveness of the SBP intervention RESULTS: A total of 29 patients (mean age 9±2 years) were included. The majority of the fractures (n=27, 93%) were length-unstable. Two patients (7%) had transverse fractures with &gt;2 cm overlap and/or weighing &gt;45 kg. All fractures healed within expected time frames. No overall leg length discrepancy (p=0.94) or coronal mechanical axis deviation (p=0.51) was observed between the affected and unaffected lower limbs at nine months post-surgery. No differences between the operated and non-operated sides were observed for hip flexion (p=0.88), hip external rotation (p=0.36), hip internal rotation (p=0.12) or knee flexion (p=0.96 CONCLUSION: SBP provides reliable outcomes in children with diaphyseal femoral fractures and is our preferred method of fixation for a) length-unstable fractures; b) fractures close to the metaphysis; and c) children weighing more than 45 kg Level of evidence: Level 4 Keywords: femoral fractures, paediatric, orthopaedic surgery, children

The surgery outcomes of pediatric femoral shaft fractures and comparision of radiation risks.

Introduction:To show midterm results and compare the two methods utilized in pediatric femoral diaphysis fractures fixation and the risks of radiation.Methods:We conducted retrospective studies of 60 children and adolescent between the age of 6 to 16 years who were exposed to traumatic femoral shaft fractures and treated with methods of fixation titanyum elastic nail (EN), submuscular bridge plating (SBP) Twenty eight (18 males and 10 females) were treated with SBP (group 1), and 32 patients (18 males and 14 females) were treated with EN (group 2).Results:The mean age of the patients was 10,3 years. Duration of follow-up was 29.8 months. Mean union time was 7,4 weeks (range, 6-10 weeks). Operative time was on average 60.6 minutes. Considering Flynn’s criteria, the results of treatment was excellent in 50, good in 4 and poor in 6 cases.Conclusions:In the surgical treatment of pediatric femoral shaft fractures, fixation techniques such as submuscular bridge platingand elastic nails were found to have similar fracture healing and complication rates. An orthopaedic surgeon must protect himself, his personnel and the patient from radiation exposure. Open reduction internal plate fixation can be chosen as an alternative treatment for children who do not cause radiation exposure to the femoral fracture. (www.actabiomedica.it)

Titanium Elastic Nails Are a Safe and Effective Treatment for Length Unstable Pediatric Femur Fractures.

Controversy exists regarding the treatment of length unstable pediatric femoral shaft fractures. The purpose of this study was to investigate the outcomes of skeletally immature children with length unstable femur fractures treated with titanium elastic nails (TENs). A retrospective review was conducted on all patients with femoral shaft fractures at a tertiary care pediatric hospital from April 2006 to January 2018. Patients with femoral shaft fractures treated with TEN and minimum 6 months follow-up were included. Exclusion criteria were age 11 years or above, weight >50 kg, pathologic fracture, and neuromuscular disorders. Femur fractures were categorized into 2 groups: length unstable (spiral, comminuted, or long oblique fractures) versus length stable (transverse and short oblique). Complications and reoperations were compared between the groups. A total of 57 patients with 58 femoral shaft fractures were included. The mean age was 5±2 (1 to 11) years and mean follow-up was 20.4±18.1 (6.0 to 81.2) months. The mean weight was 22.9±7.7 (11.0 to 40.5) kg. There was no difference in age (P=0.32), weight (P=0.28) or follow-up length (P=0.57) between patients with length unstable fractures and those with length stable fractures. A total of 32/58 (55%) fractures were length unstable and 26/58 (45%) were length stable. Mean time to union was 4.6 months, and there was no significant difference in mean time to union between the 2 groups (P=0.71). Thirty-one complications occurred in 27 patients. There was no difference between groups in the incidence of major complications requiring revision surgery (P=0.68) and minor complications that did not require revision surgery (P>0.99). In children with femoral shaft fractures treated with TEN, there was no difference in the incidence of complications or reoperations between those with length unstable fractures and those with length stable fractures. TEN are a safe and effective choice for operative fixation of length unstable femoral shaft fractures in children. Level III-retrospective comparative study.

Does Time to Treatment of Pediatric Femoral Shaft Fractures Impact Clinical Outcomes?

Purpose: One quality measure used by USNWR and other entities is time to treatment for isolated pediatric femoral shaft fracture. Hospitals that are able to provide at least 80% of pediatric patients with an operating room start time within 18 hours of admission to the emergency department receive more points towards a better pediatric orthopedic ranking. Therefore, it is important to determine whether the 18 hour cut-off time to treatment of pediatric femur shaft fractures actually affects clinical outcomes. We hypothesize that there are no differences in outcomes and complication rates for patients who receive treatment within 18 hours compared to those who receive treatment after than 18 hours.Methods: A retrospective review was conducted to compare clinical outcomes of 174 pediatric patients (age &lt; 16) with isolated femur shaft fractures (Injury Severity Score = 9) from 1997 to 2017 at a single level I pediatric trauma center. The two groups compared were those receiving treatment within 18 hours of ED admission (N = 87) or greater than 18 hours (N = 87).Results: Patient, injury, and surgical characteristics were similar between the early and delayed treatment groups, including mean age (7.5 vs. 8.1 years) with almost identical numbers of children in age categories: 0-4 years, 4-9, 10-13, and 14-15 years. Patients who received treatment within 18 hours were more frequently immobilized post-operatively (70.1% versus 52.9%, p = 0.0362) and had a shorter median length of stay in the hospital (2 vs. 3 days, p = 0.0047). There were no statistical differences in any outcomes including surgical site infection, time to weight-bearing (48 days vs 53 days), time to complete radiologic fracture healing (259 vs. 232 days), range of motion, angular deformity, leg length discrepancy, loss of reduction, or persistent pain/tenderness.Conclusions: Treatment of pediatric femur shaft fractures within 18 hours does not impact clinical outcomes, but may result in one additional day of hospitalization.Significance: It is important that national quality measures are supported by evidence based data so that as hospitals seek to meet quality standards, patient outcomes will also improve. Treatment of a femoral shaft fracture with 18 hours resulted in one day shorter length of stay but no long-term detectible differences in patient outcomes.

A clinical study of treatment of paediatric femoral shaft fractures with elastic intramedullary nail

Background: The fractures of paediatric femoral shaft is a common major fracture treated by Orthopaedic surgeon. The treatment of femoral shaft fractures in children is a subject of controversy. It is conventionally managed by traction and hip spica casting. Although the majority heals without long term sequelae but the closed intramedullary operative procedure allows early weight bearing and early rehabilitation. It has the advantage of haematoma preservation and restoration of continuity of bone.Methods: Twenty one children of aged 6-14 years with femoral shaft fractures were treated with elastic intramedullary nails. Seventeen fractures were in middle third, two in proximal third and two in distal third. Fourteen fractures were transverse, three oblique, two were spiral and two were comminuted. Average injury surgery interval was 5 days. All fractures were treated by closed reduction and elastic intramedullary nails. The patients were assessed clinically and radiologically for two years. The final results were evaluated using the criteria of Flynn et al.Results: Results were assessed for range of motion (ROM), irritation at the distal end of nail, deformity, limb length discrepancies and union. Radiologically union was achieved in a mean time of 9 weeks (6-12 weeks). The most common problem encountered was soft tissue discomfort near knee joint. Excellent results were achieved in 14 patients (67%), successful results in 5 patients (23%) and poor results in 2 patients (10%).Conclusion: It is concluded that paediatrics femoral shaft fractures treated by elastic intramedullary nail gives satisfactory results with minimal complications.