Shaft Fractures In Children Research Articles

Humeral Shaft Fractures in Children Incidence, Management and Treatment Effects.

Humeral shaft fractures are relatively rare in children, with incidence between 0.4% and 3% of all fractures in children and between 10% and 20% of all humeral fractures. The purpose of our study was to retrospectively evaluate all humeral shaft fractures treated at children's trauma center from january 2012 till december 2021. We retrospectively evaluated the group of 104 skeletally immature patients with humeral shaft fracture treated in our hospital. We have analyzed: age; sex; fracture type, management; time of bone healing; final effect and complications. The non-surgical group consisted of 73 patients (27 girls and 46 boys) with an average age of 8.03 (0.6 - 17.7), while the surgical group consisted of 31 patients (16 girls and 15 boys) with an average age of 12.47 (5,7- 17.8). The mean follow-up was 7.65 months (4-12) in non-surgical group, and 13.38 months (4-24) in surgical group. We have analyzed the results statistically, confirming increase the frequency of the above-mentioned fractures and increase the number of patients treated with surgery. We achieved good effect in all patients. 1. Humeral shaft fractures in children are relatively rare. Although in recent years, we have observed an increase of their frequency; 2. The vast majority of humeral shaft fractures are treated non-surgically with good clinical results; 3. Increase of number of patients treated surgically has been noticeable in the last decade; 4. Surgery is associated with a relatively low risk of complications and allows for cast withdrawal, which significantly improves the patients comfort.

Flexible intramedullary nails or Spica casting? A meta-analysis on the treatment of femur fractures in preschool children aged 2-5 years.

The objective of this study is to conduct a meta-analysis (1) to evaluate outcomes of flexible intramedullary nails (FIN) versus Spica casting for treating femur shaft fractures in children aged 2-5 years and (2) to investigate the associated complications. The PubMed , Cochrane Library , Embase and Web of Science databases were searched to identify available studies comparing the outcomes of FIN and Spica casting for the treatment of femoral shaft fracture in preschool children. Meta-analysis was conducted with adherence to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Eight observational studies involving 4995 patients were included. Two were judged to be of moderate quality, with the remainder being high quality. There were 1573 patients treated by FIN and 3422 by Spica casting. Compared to Spica casting, FIN allowed a quicker return to normal activities (40.49 ± 13.43 vs. 46.97 ± 14.32 days; P < 0.001), had a lower incidence of malunion (0.88 vs. 4.19%; P = 0.01) and unplanned interventions (2.87 vs. 7.53%; P < 0.001), but had slightly longer hospital stay (2.01 ± 1.01 vs. 1.10 ± 0.93 days; P = 0.01) and required a second surgery to remove the nails. Compared with Spica casting, FIN has the advantages of faster returning to normal activities and lower incidence of residual deformities and unplanned reoperation, but a slightly longer time of hospitalization and needs a second surgery to remove the hardware. Existing studies on duration of care and financial burden are insufficient, so further studies are warranted on multicenter and high-level evidence studies. Level of evidence: III.

Leg length discrepancy after skeletal maturity in patients treated with elastic intramedullary nails after femoral shaft fractures in childhood.

Purpose:The purpose was to study radiographic and perceived leg length discrepancy after skeletal maturity in patients treated for femoral shaft fractures with elastic stable intramedullary nails in childhood.Methods:Thirty-five adults underwent standing radiographs and answered a questionnaire regarding perception of leg length discrepancy. Demographic data, fracture characteristics, angulation, stability of fixation, and callus formation, at time of fracture, were assessed.Results:Mean age at fracture was 10.2 (4.9–16.7) years, and mean follow-up time was 11.1 (3.8–16.8) years. In 8 of 35 participants, the fractured limb was 11–15 mm longer than the non-fractured, and in 16, 1–10 mm longer. In eight participants, the fractured limb was 1–10 mm shorter than the non-fractured, and in three participants, 12–23 mm shorter. The younger the child, the greater the lengthening (Rs = −0.49, p = 0.003). The greater the femoral angulation at time of fracture, the greater the shortening (Rs = 0.42, p = 0.013). There was no significant correlation between stability of fixation or callus formation 1 month postoperatively and radiographic leg length discrepancy after skeletal maturity. Fourteen (40%) had perception of leg length discrepancy at follow-up, of whom eight had a radiographic leg length discrepancy of 10–24 mm.Conclusion:Treatment with elastic stable intramedullary nail of femoral shaft fracture in childhood may result in radiographic leg length discrepancy. Younger children were more prone to lengthening and should possibly be assessed before skeletal maturity. The degree of fracture stability or callus formation at the time of fracture did not significantly affect leg length discrepancy. Perception of leg length discrepancy was not necessarily associated with a radiographic leg length discrepancy (≥10 mm).Level of evidence:level IV, case series.

Retrograde intramedullary nailing of the radius in children: A pilot magnetic resonance imaging study of soft-tissue findings.

Purpose:Unstable forearm shaft fractures in children are preferably treated surgically using elastic stable intramedullary nails. The radius is nailed retrograde from the distal metaphysis. There is a risk of surgery-related soft-tissue complications during the operation. Close evaluation of occult surgery-related soft-tissue lesions has not been possible previously, due to the titanium alloy hardware used in the process. The aim of the present study was to evaluate the potential findings in the surrounding soft tissues after intramedullary nailing of the radius, by using magnetic resonance imaging.Methods:The study population comprised 15 pediatric patients with forearm shaft fractures treated by polylactide-co-glycolide biodegradable intramedullary nails and postoperatively evaluated via magnetic resonance imaging. The main outcome was signal abnormality in any tendon at the entry point postoperatively. Secondarily, other changes in the soft tissues related to nailing were determined. Furthermore, the precise location of the entry point and the anatomic characteristics of the soft-tissue tunnel were described.Results:In total, 5 of 15 patients (33.3%) had transient signal pathology in a tendon postoperatively. Edema around the superficial radial nerve was detected in 13 of 15 patients (86.7%). The most common surgical approach was between the extensor pollicis brevis and the extensor carpi radialis longus tendons, which was applied in 10 of 15 patients (66.7%).Conclusions:One in three patients exhibited transient and occult surgery-related intraparenchymal signal pathology in a tendon, after forearm intramedullary nailing. Caution with surgical prepare of the soft-tissue cleavage is recommended.Level of evidence: IV

Elastic Stable Intramedullary Nailing and Temporary External Fixation for the Treatment of Unstable Femoral Shaft Fractures in Children Aged 5-11 Years Old: A Retrospective Study of 28 Cases.

PurposeUnstable femoral shaft fractures (UFSFs) in children aged 5–11 years remain challenging due to their intrinsic instability. The aim of this study was to evaluate the clinical and radiographic outcomes of UFSF in children aged 5 to 11 years managed by the combined use of ESIN and temporary EF.MethodsChildren with UFSF (long oblique and comminuted) treated by ESIN and temporary EF were retrospectively reviewed. Sex, age at injury, side involved, type of fracture, presence or absence of associated lesions or neurovascular complications, type of treatment, time from trauma to surgery, duration of surgery, radiation exposure and length of postoperative immobilization were collected from the medical charts. Radiological and functional outcomes were evaluated according to Beaty's and Flynn's criteria, respectively.ResultsA total of 28 consecutive patients with closed or open (Gustilo type I or II) UFSF were reviewed (18 boys and 10 girls). The mean age at injury was 8.7 ± 1.6 years (range, 5–11); the average weight was 38.1 ± 7.6 kg (range, 26–55). The mean hospital stay was 3.7 ± 1.4 days (range, 2–7), and the mean time to EF and ESIN removal was 6.5 ± 1.1 weeks (range, 4–8) and 9.4 ± 1.6 months (range, 6–12), respectively. Twenty-seven out of 28 patients had excellent radiographic outcomes according to Beaty's criteria, and 24/28 had excellent functional outcomes according to Flynn's criteria. Overall, 4 complications (14.3%) were recorded. No statistically significant correlation was found between complication rates and sex, age, weight or fracture characteristics (P < 0.05).ConclusionsThe combined use of ESIN and temporary EF provides good clinical and radiological outcomes in children with UFSF aged between 5 and 11 years, with a reduced complication rate.

Functional outcome of elastic intramedullary nailing for femoral shaft fractures in children

Background: Pediatric femoral shaft fracture is the most frequent fracture type in orthopedic practice in which males are affected more commonly than females. Currently, intramedullary fixation for the managing of femoral shaft fracture in children is widely used worldwide, including Iraq, which overcomes most of the difficulties related to other treatment modalities. Objectives: This study aimed to determine the clinical, functional, and radiological consequences of pediatric femoral shaft fractures achieved with a titanium elastic nail system (TENS). Materials &amp; Methods: In this study, 28 children aged 5-10 years with femoral shaft fracture admitted to Shar Hospital, Sulaimaniyah, Republic of Iraq, were enrolled. Their fractures were fixed with Titanium Elastic Nail (TEN), in which a pair of the same-sized nail was used for each fracture. The outcomes were assessed using Flynn’s scoring criteria. Finally, the patients were discharged the next day and followed up after 2, 4, 8, 12 and 20 weeks of surgery. Results: Based on Flynn’s score assessment, the outcome of 85.71% of patients were excellent, 12.5% were satisfactory, and 1.79% were poor. All patients were showed a radiological unification and a conceivable full weight-bearing in a mean time of ~ 9 weeks, while their full knee variety of movement was attained in 2 months. Conclusions: TENS is a potential means to treat femoral shaft fractures in children as it is a simple, safe, minimally invasive, and physeal-protective with fewer complications and a high rate of good and excellent outcomes.

Outcome of Fractures SOF in Children Treated with Early Hip Spica: A Prospective Study

Background: In children, femoral shaft fractures are usually treated by initial performance and durability for 3 to 4 weeks, followed by an additional period of immobilization in a hip spica cast until union occurs. However, such treatment would involve prolonged hospital stays, thereby increasing the cost and occupancy of hospital beds. Early hip spica cast application of femoral shaft fractures in children is a valuable alternative to the traditional treatment method. It allows for a short hospital stay, thereby avoiding all the problems associated with prolonged hospitalization. Methods: This prospective study was conducted on 20 patients. Multicentered based non-randomized evaluations were performed in Modernized District Hospital, Joypurhat, and Rajshahi Medical College Hospital, Rajshahi, Bangladesh, from January 2020 to April 2022. With femur shaft fractures over two years. All the children of both sexes from 2 to 12 years of age with fractures shaft of the femur presented within day one of injury. Follow-up was done in OPD for up to 6 months. The functional result was assessed according to Flynn’s scoring criteria. Results: The mean age of the patient was 5.65 years, ranging from 2 to 12 years. The male-female ratio was 3:1. The mean duration of hospital stay was 4.1 days. Radiological union in all cases was achieved in a mean time of 7.65 weeks. Full weight-bearing was possible in a mean time of 10.07 weeks. The result was excellent in sixteen patients (80%), successful in two (10%), and poor in two patients (10%). Conclusions: Early spica cast is a simple, effective, and definite treatment method with minimal complications and acceptable results in the pediatric age group.

Results after skin traction for femur shaft fractures in children below the age of four years

PurposeNonsurgical management has been identified as the treatment of choice for femoral shaft fractures in children below four years of age. For various reasons, the surgical approach has become increasingly popular in recent years. The aim of this study is to report results after vertical skin traction and analyze the benefits of this technique as well as to point out advantages compared with surgery in this age group.MethodsThe authors performed a retrospective data analysis, including all patients with femoral shaft fractures below the age of four who were treated with vertical skin traction at our institution between January 2006 and December 2016.ResultsSkin traction for a femoral shaft fracture was performed for 36 patients (mean age 1.6 years; 1 day–3.5 years). The mean duration of traction was 18.5 days (14–30). Complications included soft tissue affections (n = 5), which all healed spontaneously. Consolidation was observed in all fractures. Initial axial deviations and shortening did not change during traction until consolidation (p > 0.05), and no relevant torsion deformity occurred (p = 0.01). Patients gained full weight-bearing within 12.3 days (7–40) following end of traction. At the final follow-up, after a mean of 29.3 months (12–192), leg-length discrepancy (mean 7.1 mm; 5–20) was found on radiograms in nine cases, and axial deviations (mean 7.7°; 5–25) were documented in seven cases. None of the patients had limitations in daily activities or sports.ConclusionSkin traction is a technically easy, safe, and non-invasive treatment modality for femoral shaft fractures in children below the age of four years. Strong results are obtained benefited from a high potential of growth-related correction, and in principle no anesthesia is needed. A prolonged hospitalization and socio-economic factors maintain the ongoing debate in comparison with the surgical approach.Level of evidenceLevel III, retrospective.

Evaluation of functional outcome of forearm fracture in children treated with elastic nail (TENs)

Background: Forearm fractures are one of the most common injuries sustained by children and both bone forearm fractures are estimated around 40% of all pediatric fractures. Pediatric forearm fractures occur in approximately 1 in 100 children per year. Forearm shaft fractures in children are usually treated with closed reduction and cast immobilization and a good functional outcome is obtained, but few patients with gross displacement, angulations, soft tissue swelling due to edema, children nearing skeletal maturity, proximal third fractures, open fractures and displacement after closed manipulation and cast immobilization require surgical intervention. Greater controversy exists regarding the optimal method of fixation in children. Fractures in this age group that cannot be maintained in acceptable alignment with closed reduction can be treated with either intramedullary nails or open reduction and internal fixation with plates. The purpose of this study was to investigate the indications, techniques, clinical results, functional outcomes, possible complications and means of avoiding them in unstable forearm fractures in children treated with titanium elastic nails (TENs). Methods: Our prospective interventional study included Forty five children after application of inclusion and exclusion criteria, consent for study was taken from the parents.

Tibial shaft fractures in children: flexible intramedullary nailing in growing children especially weighing 50 kg (110 lbs) or more.

Currently the gold standard in surgical treatment of displaced tibial shaft fractures in children with open growth cartilage is elastic stable intramedullary nailing (ESIN). The purpose of this study is the analysis of indications, complications, and duration of treatment using intramedullary flexible nails in children who are still growing but especially weighing 50 kg or more. Hospital records from 2017 to 2020 were retrospectively reviewed to identify the children from 4 to 17 years of age with displaced tibial shaft fractures admitted to the hospital. Only children with open growth cartilage, with a minimum of 6 months of follow-up and complete clinical data, were included. Studies of 91 children xwere analyzed. The average patient age at the time of the injury was 10.88 ± 2.82 years. In the entire group, 31.9% children weighed 50 kg or more, and 68.1% of the children were below this weight. All children were treated using ESIN. The mean time to nail removal was 8.4 ± 4.09 months in the whole group of children stabilized with ESIN. There were no differences in the two groups depending on the weight ( P = 0.637). Only two adverse events were observed. This study demonstrates that the use of ESIN in displaced tibial shaft fractures in growing children weighing 50 kg or more is acceptable and safe. The discussion to be made is whether it is still an acceptable method of treatment for this type of fracture due to the progressive obesity epidemic in children and adolescents.

Medial clavicle shaft fractures in children and adolescents: differences from adults and management.

Clavicle fractures are a common injury in the pediatric and adolescent population. Most fractures are located in the middle third of the clavicle. There has been no information in the literature regarding the management of extra-physeal medial clavicle shaft fractures in this population. The objective of this study is to evaluate demographic and injury characteristics, management options and clinical outcomes of medial clavicle fractures in children and adolescents and differentiate them from those in adults. A retrospective review was performed at a single institution to identify patients with medial clavicle shaft fractures. Radiographs, clinical features and patient-reported outcomes (QuickDASH) were analyzed. Eight patients were identified with medial clavicle fractures. Two fractures could not be diagnosed on anteroposterior radiographs. Both operative (four patients) and nonoperative (four patients) treatment had excellent radiographic and clinical outcomes, irrespective of initial displacement. Compared to high-energy and life-threatening injuries in adults, these fractures in children and adolescents were sports-related and isolated fractures. Conservative treatment should be considered for medial clavicle fractures in children and adolescents. These fractures are distinct from their adult counterparts and do not lead to increased morbidity or mortality.

Operative Choice for Length-Unstable Femoral Shaft Fracture in School-Aged Children: Locking Plate vs. Monolateral External Fixator.

BackgroundLocking plate (LP) is a good choice in the treatment of length-unstable femoral shaft fracture in children. Monolateral external fixator (EF) has been reported for this condition for decades. This study aims to compare the clinical outcomes of school-aged children with length-unstable femoral shaft fracture treated with LP vs. EF.MethodsPatients aged 5–11 years old with length-unstable femoral shaft fractures treated at our institute from January 2014 to January 2018 were retrospectively reviewed and categorized into LP and EF groups. The preoperative data, including baseline information of the patients, radiographic parameters, and types of surgical procedure, were collected from the hospital database, and postoperative data, including complications, were collected during the follow-up visits.ResultsOverall, 36 patients (average, 8.2 ± 2.1 years; male, 20; female, 16) in the LP group and 35 patients (average, 8.3 ± 2.3 years; male 20, female 15) in the EF group were included. There was significantly less operative time for EF (45.4 ± 7.8 min) compared with LP (67.8 ± 11.3 min) (P < 0.001). As for the frequency of fluoroscopy, there was a significant difference between the EF (13.9 ± 2.4) and LP (16.5 ± 3.2) groups (p < 0.001). The rate of major complications was not significantly different between these two groups. There was a significant difference between the EF group (11.2 ± 5.8 mm) and the LP group (7.5 ± 1.6 mm) group concerning limb length discrepancy (P < 0.001).ConclusionBoth LP and EF produce satisfactory outcomes in school-aged children with length unstable femoral shaft fractures. External fixation remains a viable choice without the necessity of secondary surgery for hardware removal.

Impact on Family Functioning of Immediate Spica Casting for Pediatric Femur Fractures: An Ecological Study

Background: Traditional treatment for femoral shaft fractures in children aged 6 months to 6 years old is closed reduction and immediate spica casting. Pediatric femur fracture and spica cast treatment place unique burdens and stresses on the family. The purpose of this study was to evaluate the impact on the family from an ecological perspective of immediate spica casting for femoral shaft fractures in children using appropriate validated family functioning questionnaires. Methods: Families of 46 children aged 0.5 to 6.0 years old who were treated with immediate one and a half leg spica casting for femur fracture were surveyed using the Impact on Family Score (IFS), the Feetham Family Functioning Survey (FFFS), and qualitative comments. The impact of spica cast treatment on family functioning was determined for multiple domains and compared between subgroups. Results: Spica cast treatment for pediatric femur fractures had major impacts on the families of 46 children with a mean age of 2.9 years (range, 0.5–6.0 years) across multiple domains. The IFS demonstrated greater impact of spica cast treatment than treatment for children with major chronic illnesses. There was a greater impact on family for school age children (5–6 years old) compared to younger children (0.5–4 years old) for the overall IFS score, the general impact IFS domain, the disruption of family IFS domain, the coping IFS domain, and the overall FFFS discrepancy score. There was greater impact on family for children of working parent(s) compared to children with a parent at home for the overall IFS score, the general impact IFS domain, the disruption of family IFS domain, the coping IFS domain, the financial impact IFS domain, and the overall FFFS discrepancy score. There was no correlation between duration of time spent in hip spica cast with either IFS or FFFS discrepancy score. Conclusions: Pediatric femur fracture and spica cast treatment can have a major impact on family functioning, particularly in school age children and in families with working parents. Providers should consider the impact of treatment on family functioning and recognize that each patient and family unit require education and varying levels of support. Education to families of children undergoing spica cast treatment may help prepare them for the various ways their household dynamics could be affected throughout their child’s treatment.

PROSPECTIVE STUDY OF CLINICAL OUTCOME OF FRACTURE SHAFT FEMUR IN CHILDREN TREATED WITH TITANIUM ELASTIC NAILING: OUR RESULTS

Introduction: Femur fracture in children between 5 and 15 years is a common injury with a variety of operative and non-operative management options. There remains debate as to the optimal treatment for a given patient and fracture. Our aim was to assess functional outcome of a large number of patients after their femur fractures with a titanium elastic nailing (TEN). Methods: This was a prospective randomized study comprised 50 patients with displaced diaphyseal femur fractures treated with TEN. Two nails were used in fracture. The patients were followed up at 2nd week, 1 month, 3 months, and 6 month after surgery. Results were evaluated by flynn’s scoring criteria at each follow-up visit. Results: At the end of 6 months, out of 50 patients, excellent result was achieved in 45 patients (90%) and good in five patients (10%). No poor outcome seen. Intramedullary fixation by Tens is an effective treatment of fracture of femur in properly selected patients of the 5–15 years age group. Conclusion: The treatment with femoral shaft fracture in children between the age group of 5–15 years by titanium elastic nail is ideal as it hastens fracture union, reduce rate of mal union, shortening, and allow early rehabilitation.

A study on occurrence of paediatric diaphyseal fractures of femur in Indian population

Background: There was an increased interest in the operative treatment of paediatric fractures in the past two decades, although debate persisted over its indications. There is a little disagreement concerning the treatment of femur fractures in children less than 5 years (POP cast) and adolescents older than 15 years (locked intramedullary nailing). Controversy persists regarding the age between 5 to 15 years. Several treatment options for femoral shaft fractures in children and adolescents have been described. Children below the age of 3 can be treated with a cast or extensional devices. In the past two decades, the management of displaced femoral shaft fractures in older children has gradually evolved toward a more operative approach due to a more rapid recovery, faster reintegration of the patients and possible negative effects of immobilization even in children. Orthopaedic surgeons will continue to face the challenge to treat this age group with less morbidity at a lower cost, as no clear guidelines have been available until now despite efforts done initially by French surgeons, later on by European surgeons and recently by the Paediatric Orthopaedic Society of North America (POSNA). Conclusion: There was no significant association observed between clinical variables (age, gender, mode of injury, pattern of fracture and time interval between trauma and surgery) and incidence of complications.

Management of femoral shaft fracture in children by using minimal invasive plate M.A.Mikhael, A.I.Ali and M.M.El Karmany

Management of femoral shaft fracture in children by using minimal invasive plate M.A.Mikhael, A.I.Ali and M.M.El Karmany

Complication of Early Application of One and a Half Hip Spica for Femoral Shaft Fractures in Children below Six Years in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Introduction: Hip spica with or without prior traction has become a standard treatment for closed isolated femoral shaft fracture in children below six years. The time of hip spica application is not uniform in the existing literature. The aim of this study is to find out the prevalence of complication of early application of one and a half hip spica for femoral shaft fractures in children below six years in a tertiary care hospital. Methods: A descriptive cross-sectional study was done among 42 children who were managed with early hip spica application (within 72 hours) for femoral shaft fracture from January 2015 to December 2020 after receiving ethical clearance from Institutional Review Committee. Convenient sampling technique was done. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Complication was seen in nine (21.4%) (95% Confidence Interval= 9.02-33.84) patients. Skin breakdown from local pressure had the highest prevalence in our study which was documented in three (7.14%) patients who resolved with conservative treatment. Conclusions: The prevalence of complication of early application of one and a half hip spica for femoral shaft fractures in children below six years was similar to other studies done in similar setting.

External fixation versus elastic stable intramedullary nailing in the treatment of open tibial shaft fractures in children

IntroductionExternal fixator (EF) is a popular choice for open tibial fractures, but pin tract infection (PTI) and refracture are common complications. Elastic stable intramedullary nail (ESIN) has been reported in the treatment for open tibial fractures. This study aims to compare the clinical outcomes of EF vs. ESIN in the treatment for open tibial shaft fracture in children retrospectively.MethodsPatients aged 5–11 years with Gustilo-Anderson II and IIIA tibial shaft fracture treated at our institute from January 2008 to January 2018 were reviewed retrospectively and categorized into EF and ESIN groups. Patients with pathological fracture, neuromuscular disorder, metabolic disease, previous tibial fracture or instrumentation, and polytrauma were excluded. Patients with follow-up < 24 months or incomplete medical records were also excluded.ResultsIn all, 55 patients (33 males, 22 females) were included in the EF group, whereas 37 patients (21 males, 16 females) were included in the ESIN group. There was no statistically significant difference between the two groups concerning sex, age, body weight, duration from injury to surgery, Gustilo-Anderson (GA) classification, and concomitant injuries. There was no case of nonunion and malunion in either group. The angulation at the latest follow-up was higher in the EF group than the ESIN group (P < 0.01). The radiological union was faster in the ESIN group (7.0 ± 0.9 weeks) than those in the EF group (9.0 ± 2.2 weeks) (P < 0.01). Limb length discrepancy (LLD) was more in the EF group (12.1 ± 4.4, mm) than in the ESIN group (7.3 ± 4.3, mm) (P < 0.01).ConclusionESIN is a viable option in selected patients of GA grade II and IIIA open tibial fractures with comparable clinical outcomes as external fixator. Pin tract infection is the most troublesome complication in the EF group while implant prominence is a nuisance in the ESIN group.

Letter to the Editor With Respect to: Comparison of Short-leg and Long-leg Casts for the Treatment of Distal Third Tibial Shaft Fractures in Children, Barnett, Scott A. MD; Fontenot, Bailli BS; Leonardi, Claudia PhD; Gonzales, Joseph A. MD; Gargiulo, Dominic DO; Heffernan, Michael J. MD. March 2021 - Volume 41 - Issue 3 - pp. e259-e265.

Tribe, Howard C. BSc (Hons), PgCert (T&O), MEd, PhD, MBBS, MRCS; Lindisfarne, Edward FRCS (T&O)Author Information

Legg-Calvé-Perthes disease following Ender nail fixation of a pediatric femoral fracture.

Introduction and importanceLegg–Calvé–Perthes disease (LCPD) sometimes occur in children, however it is difficult to diagnose it at the early stage especially in the cases there are no complaints of symptoms. Femoral shaft fractures in children cause various complications such as leg-length discrepancy, nonunion and malunion, refracture, and osteonecrosis of the femoral head. We presented a rare case in which a pediatric patient developed LCPD after femoral shaft fracture.Case presentationA healthy 8-year-old boy sustained a left femoral diaphyseal fracture following a pedestrian car accident. Fixation was achieved using retrograde Ender nails; bone union was confirmed at 3 months postoperatively, and the Ender nails were removed at 8 months postoperatively without any problems. Unfortunately, the morphological change of the ipsilateral femoral head and subtle symptoms were missed until the femoral head collapsed. LCPD was successfully treated with intertrochanteric varus osteotomy, which achieved a good clinical result.Clinical discussionAlthough the reason for the ipsilateral LCPD after the femoral shaft fracture is unclear, this case highlights the need for close postoperative follow-up of pediatric femoral fractures resulting from high-energy trauma to prevent the misdiagnosis of this coincidental complication.ConclusionThis case report describes a missed ipsilateral LCPD after a femoral diaphyseal fracture caused by high-energy trauma. Close postoperative follow-up with a detailed assessment and vigilant interpretation of postoperative radiography is imperative to avoid delayed/missed diagnosis of conditions for which early management may provide better outcomes.