Shaft Fractures In Adolescents Research Articles

Residual Deformity and Outcome in Non-Surgically Treated Tibial Shaft Fractures in Adolescents

Background: The limited potential for correction of malalignments due to the impending physeal closure predisposes adolescents to inadequate alignment of tibial shaft fractures, hence the need for close to anatomic reduction as possible. As such, there is an increasing trend of surgical treatment of tibial shaft fractures, especially in the adolescent population. While properly done casting and immobilization are still carried out in appropriately selected tibial shaft fractures in the pediatric population, local data for radiographic and clinical outcomes of these non-surgically treated are yet to be explored. Objective: The primary objective of this study was to report residual lower limb deformity of tibial shaft fractures treated non-surgically in adolescents nearing skeletal maturity, identify factors or fracture characteristics that may predict these deformities, and report the clinical outcomes using the Lower Extremity Functional Scale. Methodology: A total of 31 adolescents nearing skeletal maturity at the time of injury with acute closed tibial shaft fractures treated non-surgically at the Philippine Orthopedic Center from 2017 to 2020 were included in the study. Radiographic analysis were done to evaluate skeletal maturity and residual sagittal & coronal angulation. Rotational alignment and leg length discrepancies were evaluated clinically. Functional outcome was measured with using the Lower Extremity Functional Scale (LEFS). Result: Coronal plane angulation (r=-0.397; p=0.05) and leg length discrepancy (r=-0.394; p=0.05) were shown to have significant inverse correlation with Lower Extremity Functional Scale (LEFS) scores. While sagittal plane angulation, tibial rotation, and fracture pattern were shown to have non-significant correlation. Significant correlation was also noted between presence of an ipsilateral fibular fracture and coronal plane angulation (p = 0.007). Lower Extremity Functional Scale (LEFS) scores ranged from 75 to 80 with a mean of 79.39. Conclusion: The radiographic and clinical outcomes of children nearing skeletal maturity with isolated acute tibial shaft fractures treated non-surgically showed that the current method of closed reduction and casting followed by close monitoring remains to be useful and effective.

Two-Year Functional Outcomes of Operative vs Nonoperative Treatment of Completely Displaced Midshaft Clavicle Fractures in Adolescents: Results From the Prospective Multicenter FACTS Study Group

Background: The optimal treatment of midshaft clavicle fractures is controversial. Few previous comparative functional outcome studies have investigated these fractures in adolescents, the most commonly affected epidemiologic subpopulation. Purpose/Hypothesis: The purpose was to prospectively compare the outcomes of operative versus nonoperative treatment in adolescents with completely displaced midshaft clavicle fractures. The study hypothesis was that surgery would yield superior outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: Patients aged 10 to 18 years treated for a midshaft clavicle fracture over a 5-year period at 1 of 8 pediatric centers were prospectively screened, with independent treatment decisions determined by individual musculoskeletal professionals. Demographics, radiographic clinical features, complications, and patient-reported outcomes (PROs) were prospectively recorded for 2 years. Regression and matching techniques were utilized to adjust for potential age- and fracture severity–based confounders for creation of comparable subgroups for analysis. Results: Of 416 adolescents with completely displaced midshaft clavicle fractures, 282 (68) provided 2-year PRO data. Operative patients (n = 88; 31%) demonstrated no difference in sex (78% male) or athletic participation but were older (mean age, 15.2 vs 13.5 years; P < .001), had more comminuted fractures (49.4% vs 26.3%; P < .001), and had greater fracture shortening (25.5 vs 20.7 mm; P < .001) than nonoperative patients (n = 194; 69%). There was no difference in mean PRO scores or rates of “suboptimal” scores (based on threshold values established a priori) between the operative and nonoperative treatment groups (American Shoulder and Elbow Surgeons, 96.8 vs 98.4; shortened version of the Disabilities of the Arm, Shoulder and Hand, 3.0 vs 1.6; EuroQol [EQ] visual analog scale, 93.0 vs 93.9; EQ–5 Dimensions index, 0.96 vs 0.98), even after regression and matching techniques adjusted for confounders. Operative patients had more unexpected subsequent surgery (10.4% vs 1.4%; P = .004) and clinically significant complications (20.8% vs 5.2%; P = .001). Overall, nonunion (0.4%), delayed union (1.9%), symptomatic malunion (0.4%), and refracture (2.6%) were exceedingly rare, with no difference between treatment groups. Conclusion: Surgery demonstrated no benefit in patient-reported quality of life, satisfaction, shoulder-specific function, or prevention of complications after completely displaced clavicle shaft fractures in adolescents at 2 years after injury. Registration: NCT04250415 (ClinicalTrials.gov identifier).

Tibial shaft fractures in the adolescents: treatment outcomes and the risk factors for complications

Background: Tibial shaft fractures are common injuries in the adolescent age group. The optimal method of treatment in this age group is still controversial. It relies on several factors including patient's age, fracture pattern, fracture location, and the condition of the soft tissue envelope. The purpose of this study was to report the clinical and radiographic outcomes of adolescent tibial shaft fractures treatment at a level-I trauma center.Methods: This retrospective study reviewed consecutive patients between 10 and 18 years of age who suffered from tibial shaft fractures between 2009 and 2018 at a level-I trauma center. Outcomes of interest were the successful fracture union (primary outcome) as evaluated by the Radiographic Union Scale in Tibial fractures (RUST) and the complications (secondary outcomes).Results: Fifty-two consecutive adolescent patients treated for tibial shaft fractures using elastic stable intramedullary nails (ESIN), interlocking nails, plates and screws, external fixators, and casts were included in the study. The mean follow-up period was 27.4 months. There was no statistically significant difference in the union rate and time to fracture union between the different treatment methods. Subject weight, fracture type, and method of treatment were significant predictors for the RUST scores at 12 weeks post-operative. Adolescents with heavier bodyweight correlated with lower RUST scores (p<0.001). Open fractures were associated with significantly longer time to union (p<0.001) and lower RUST scores (p<0.001) compared to closed fractures. The patients treated with interlocking nailing showed higher RUST scores than the casting treatment group (p = 0.01). There were no statistically significant differences in complication rates between the fixation methods. Union time was significantly longer with complications than without complications (p = 0.01). Open fractures had higher complication rates compared to closed fractures. In the multivariate logistic model, patients with open fracture were 5.5 times more likely to have complications (OR=5.46; p = 0.04).Conclusion: Tibial shaft fractures in adolescents can be treated with several methods including ESIN, interlocking nail, plate and screws, external fixation, and casting. All are valid treatments for adolescent tibial shaft fractures and can achieve favorable outcomes. No single treatment method applies to all patients. Each method has advantages, disadvantages, and specific indications.

Operative Fixation Versus Cast Immobilization: Tibial Shaft Fractures in Adolescents.

Tibial shaft fractures are common injuries in the adolescent age group. Potential complications from the injury or treatment include infection, implant migration, neurovascular injury, compartment syndrome, malunion, or nonunion. Published literature was reviewed to identify studies which describe the management options, complications, and outcome of tibial shaft fractures in adolescents. Acceptable alignment parameters for tibial shaft fractures have been defined. Operative indications include open fractures and other severe soft tissue injuries, vascular injury, compartment syndrome, ipsilateral femoral fractures, and polytrauma. Relative indications for operative treatment are patient/family preference or morbid obesity. Closed reduction and cast immobilization necessitates radiographic observation for loss of reduction over the first 3 weeks. Cast change/wedging or conversion to operative management may be required in 25% to 40%. Flexible nailing provides relative fracture stability while avoiding the proximal tibial physis, but the fracture will still benefit from postoperative immobilization. Rigid nailing provides greater fracture stability and allows early weight bearing but violates the proximal tibial physis. Plate and screw osteosynthesis provide stable anatomic reduction, but there are concerns with delayed union and wound complications related to the dissection. External fixation is an excellent strategy for tibia fractures associated with complex wounds but also requires observation for loss of reduction. The majority of adolescent tibia shaft fractures can be successfully managed with closed reduction and cast immobilization. Unstable fractures that have failed cast treatment should be treated operatively. Flexible intramedullary nailing, rigid intramedullary nailing, plate and screw osteosynthesis, and external fixation are acceptable treatment options that may be considered for an individual patient depending upon the clinical scenario.

Risk Factors for Failure of Cast Treatment in Displaced Pediatric Tibial Shaft Fractures.

As there is a current increasing tendency to treat displaced tibial shaft fractures in adolescents surgically, it has become more important to predict failure of cast treatment for these patients. In the past, redisplacement of pediatric tibial shaft fractures has been reported at rates of 20% to 40%. Although the efficacy of the three-point index (TPI), gap index, and cast index has been demonstrated for upper extremity fractures in children, to date no index has been shown to accurately predict redisplacement for pediatric tibial shaft fractures. The aim of this study was to determine the predictive factors for redisplacement in pediatric tibial shaft fractures. In all, 157 displaced pediatric tibial shaft fractures were evaluated retrospectively. Patient age, initial and postreduction fracture angulation, shortening and translation, quality of reduction, obliquity of fracture, associated fibular fractures, and 3 indices (TPI, cast index, and gap index) were analyzed. Receiver operating characteristic analysis was performed to determine the cutoff points and logistic regression was used to show the risk factors of redisplacement. There were 53 female and 104 male patients with a mean age of 9.1 (5 to 15 y) and 45 patients developed redisplacement during the follow-up. Mean TPI and gap index and initial and postreduction fracture translation were higher in patients with redisplacement, while TPI>0.855 and postreduction translation >18% were the only independent risk factors for fracture redisplacement. No differences were observed regarding associated fibular fracture, quality of reduction, initial/postreduction angulation, and shortening. The TPI>0.855 and postreduction translation >18% are independent risk factors for redisplacement of tibial shaft fractures in children. Although the gap index can be useful, the cast index is not an appropriate tool for these fractures.

Tibia Shaft Fractures in Adolescents: How and When Can They be Managed Successfully With Cast Treatment?

Despite the increasing popularity of operative treatment in adolescent tibia fractures, casting remains a viable first-line treatment. Because the selection bias in published reports does not allow direct comparison between casting and flexible nail treatment of closed pediatric tibia fractures, it is unclear whether flexible nailing offers any advantages over casting. This overview discusses parameters of acceptable alignment, indications, techniques for successful reduction and casting, subsequent inpatient and outpatient management including wedging of casted tibia fractures, expected outcomes, and comparison of casting with flexible nailing. As with any orthopaedic procedure, careful attention to patient selection, indications, and detail facilitates successful cast treatment in this older pediatric population.

Fractured neck of femur in a child after femoral fracture fixation by intramedullary flexible nails: a case report

Since the introduction of flexible intramedullary nails, the treatment of femoral shaft fractures in adolescents has been revolutionized and this has become the routine treatment in most units, with minimal complications. We report a rare complication of an ipsilateral fractured neck of femur in a fit and healthy 12-year-old girl 6 months after treatment of a traumatic fractured femoral shaft; this was treated effectively with cannulated screws and the patient was successfully discharged without any further complication.

Management of Pediatric Femoral Fractures using K-Wires

Management of Pediatric Femoral Fractures using K-Wires

Treatment for the Femoral Shaft Fractures in Adolescents

Treatment for the Femoral Shaft Fractures in Adolescents

Closed Ender nailing of femoral shaft fractures in adolescents.

Closed intramedullary Ender nailing of 16 femoral fractures in 15 children, 9-15 years of age, was studied retrospectively. Seven patients (46%) had additional injuries. The average time to independent ambulation was 7.1 days, and hospitalization time averaged 11.4 days. There were no infections, nonunions, or malunions. On follow-up, averaging 45.2 months, no patient had deformity of greater than 10 degrees in any plane. No patient had clinical loss of motion, leg length discrepancy, or radiographic evidence of growth disturbance.