Shaft Fractures In Children Research Articles

Flexible Intramedullary Nails for Treatment of Femoral Shaft Fracture in Children, Aden, Yemen

Flexible Intramedullary Nails for Treatment of Femoral Shaft Fracture in Children, Aden, Yemen

Outcome of Titanium Elastic Nailing in the Surgical Management of Femoral-Shaft Fracture in Children

Introduction: Femoral shaft fracture is one of the most common orthopedic injuries of the children. These fractures treated non-operatively by traction followed by hip spica require prolonged hospitalization causing undue physical and psychological stress for patient and patient family. Loss of reduction is also commonly seen with hip spica that leads to unacceptable complications like angular deformities and limb length discrepancies. Titanium Elastic Nailing (TEN) is becoming widely accepted treatment for femoral shaft fractures in children due to its simplicity and physeal protective stable load sharing construct that allows early mobilization. The purpose of this study was to see the outcome of operative treatment of femoral shaft fracture in children by TEN.
 Methods: A retrospective observational study was carried out in the Department of Orthopedics in National Academy of Medical Sciences, National Trauma Center from February 2017 to January 2019. Study was undertaken in 22 children between the age group of 5-14 years with femoral shaft fractures. Fixation with TEN was done for all fractures within nine days of injury. Patients were assessed radiologically as well as clinically until fractures healed. The results were evaluated using Flynn scoring criteria.
 Results: Radiological union was seen in all cases between 6–12 weeks after surgery. The mean operating time was 58 (48-115) minute and mean hospital stay after surgery was 9 (6-15) days. Results were excellent in 14 patients (63.63%), satisfactory in 6 patients (27.37%) & poor in 2 patients (9%). Six patients had skin irritation at nail insertion site which resolved after removal of nails. Functional range of motion in both hip and knee joints of affected limb was preserved in all cases after the removal of nails.
 Conclusion: TEN is an effective and safe treatment of femoral shaft fractures in children of 5-14 years of age group.

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 …

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

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

Comment on Siddiqui et al: 'Femoral shaft fractures in children with non-ambulatory neuromuscular disorders can be effectively treated using flexible intramedullary nail'.

Comment on Siddiqui et al: 'Femoral shaft fractures in children with non-ambulatory neuromuscular disorders can be effectively treated using flexible intramedullary nail'.

Response to comment on Siddiqui et al: 'Femoral shaft fractures in children with non-ambulatory neuromuscular disorders can be effectively treated using flexible intramedullary nails'.

Response to comment on Siddiqui et al: 'Femoral shaft fractures in children with non-ambulatory neuromuscular disorders can be effectively treated using flexible intramedullary nails'.

Femoral shaft fractures in children with non-ambulatory neuromuscular disorders can be effectively treated using flexible intramedullary nails.

PurposeThere is little information in the literature regarding flexible intramedullary nails (FIN) for treating femur fractures in children with neuromuscular disorders. The purpose of this study is to investigate the outcomes of FIN for femoral shaft fractures in non-ambulatory children with neuromuscular disorders.MethodsA retrospective review was conducted on patients with femur fractures at a paediatric hospital between 2004 and 2018. Inclusion criteria were femoral shaft fracture treated with FIN. Outcomes were compared between patients with neuromuscular disorders (NM group) and a control group of those without neuromuscular disorders.ResultsA total of 37 patients with 37 femoral shaft fractures were studied (12 patients in the NM group and 25 in the control group). All NM group patients were non-ambulatory at baseline. Fractures were length stable in all 25 patients in the control group and in 2/12 (17%) patients in the NM group. All fractures healed in both groups. Three complications (all nail migrations) requiring reoperation before fracture union occurred in the NM group, yielding a major complication rate of 25% (3/12) in the NM group versus 0% (0/25) in controls (p = 0.03). Angular deformity occurred in 5/12 (42%) NM group patients and 1/25 (4%) control group patient (p = 0.009); none required reoperation.ConclusionFemur fractures in non-ambulatory children with neuromuscular disorders can be successfully treated with FIN. Angular deformities are common in this population, but had no functional impact in the non-ambulatory NM group patients. Surgeons must also be vigilant for implant prominence and skin breakdown in these patients.Level of evidenceIII

Retraction: Is Refracture a Concern Following Closed Management of Tibia Shaft Fractures in Children?

[This retracts the article DOI: 10.7759/cureus.7206.].

Is Refracture a Concern Following Closed Management of Tibia Shaft Fractures in Children?

Tibia shaft fractures account for 15% of all pediatric fractures. These fractures are often treated nonoperatively with closed reduction and long leg casting. In children treated nonoperatively, refracture can cause significant frustration to both the patient and their family in addition to a delay in resuming normal activities for several months. The purpose of this study was to investigate the rate of refracture of tibia shaft fractures treated nonoperatively at our institution. We performed a retrospective chart review of pediatric patients at one institution with the diagnosis of a tibia shaft fracture who were treated nonoperatively between January 1, 2000 and December 31, 2016. Exclusion criteria included those without complete retrievable radiographs or without radiographic confirmation of healed fracture. Patients who sustained a proximal or distal metaphysical tibia fracture or a toddler fracture were also excluded. Additionally, those with less than three months of clinic follow-up or an underlying metabolic bone disease were excluded. Data such as age, sex, body mass index, mechanism of injury, location of fracture, initial displacement, angulation, treatment, length of immobilization, and complications were recorded. The primary outcome for our study was the presence of refracture. Refracture was defined as a repeat fracture of the tibia at the same location within 18 months of the original fracture. A total of 64 patients met the inclusion criteria and were included in the study. Of the 64 patients, only one patient sustained a refracture. The refracture occurred eight months after the initial injury and required operative intervention. This rate of refracture is equated to roughly 1.5%. Conservative management of closed tibia shaft fractures with casting is an ideal treatment for pediatric fractures. Conservative management allows for avoidance of surgical intervention and low refracture rates. This study provides support regarding the adequacy of conservative management with limited complications. Although the rate of refracture still exists, patients and families should be counseled that the rate of healing without complications is about 98.5%.

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

Comparative study of day 01 spica cast versus skin traction followed by spica cast for treatment of closed femoral shaft fracture in children

Femoral shaft fractures are among the commonest fracture of lower extremity in children and commonly require hospital admission. There are various modalities of treatments both operative and non-operative. The aim of treatment is to secure union, in good alignment with length restored and early rehabilitation. objective of this study was to compare the results of day 1 spica cast and skin traction followed by spica cast in the treatment of femoral shaft fractures in children (6 months to 10 years). A total of 64 patients with fracture shaft femur of either sex aged 6 months – 10 years with closed , isolated diaphyseal femur fracture were included in this study. Case with clinical evidence of infection, pathological fractures and multiple injuries including neurovascular injuries were excluded from the study. The patients were randomly assigned into two groups, Group -1 ( n-32) patients who underwent early spica application while Group -2 ( n-32) patients underwent skin traction in followed by spica cast. Mean age in group A was 5.06 years and 5.12 years in group B (range 6 month – 10 years). Ratio of males and female in Group A and Group B was 19:13 and 20:12 respectively. Average duration of hospital stay was 1.65 days and 11.65 days in group A and group B respectively. Average total time of spica cast application was 45.13 days 49.41 days in group A and group B patients respectively. There were no significant differences between early and delayed spica regarding the complications of treatment and functional outcome. But immediate spica decreased the hospitalization time and the cost of treatment significantly with increased availability of beds while having similar result as achieved by delayed spica application.

Comparative study of day 01 spica cast versus skin traction followed by spica cast for treatment of closed femoral shaft fracture in children

Femoral shaft fractures are among the commonest fracture of lower extremity in children and commonly require hospital admission. There are various modalities of treatments both operative and non-operative. The aim of treatment is to secure union, in good alignment with length restored and early rehabilitation. objective of this study was to compare the results of day 1 spica cast and skin traction followed by spica cast in the treatment of femoral shaft fractures in children (6 months to 10 years). A total of 64 patients with fracture shaft femur of either sex aged 6 months – 10 years with closed , isolated diaphyseal femur fracture were included in this study. Case with clinical evidence of infection, pathological fractures and multiple injuries including neurovascular injuries were excluded from the study. The patients were randomly assigned into two groups, Group -1 ( n-32) patients who underwent early spica application while Group -2 ( n-32) patients underwent skin traction in followed by spica cast. Mean age in group A was 5.06 years and 5.12 years in group B (range 6 month – 10 years). Ratio of males and female in Group A and Group B was 19:13 and 20:12 respectively. Average duration of hospital stay was 1.65 days and 11.65 days in group A and group B respectively. Average total time of spica cast application was 45.13 days 49.41 days in group A and group B patients respectively. There were no significant differences between early and delayed spica regarding the complications of treatment and functional outcome. But immediate spica decreased the hospitalization time and the cost of treatment significantly with increased availability of beds while having similar result as achieved by delayed spica application.

Poor prognostic factors of femoral shaft fractures in children treated by elastic intramedullary nailing.

Introduction: Femoral shaft fractures in pediatric patients are treated by elastic intramedullary nailing using titanium or stainless-steel nails. The elastic stable intramedullary nailing behaves as an internal splint, promoting early mobilization. This type of treatment involves a minimally invasive approach, no damage to the growth plates, and no impairment of femoral head blood supply. Purpose: The aim of our study was to identify the negative predicting factors that might lead to an increased complication rate after elastic stable intramedullary nailing of femoral shaft fractures in children. Methods: We conducted a retrospective study on 137 patients with femoral shaft fractures treated by elastic stable intramedullary nailing. Patients’ age ranged between 4 and 17 years. We used data from the medical records of the patients to evaluate postoperative complications. Plain radiographs were analyzed to determine the fracture type, fracture location, and postoperative complications such as delayed union, angular deformities, and limb length discrepancies. Multivariate analysis was conducted to identify predictors for poor outcomes. Results: Complications occurred in 29 patients (21%) and consisted of delayed union, axial deformities, or lower limb length discrepancies. In the group of patients that suffered from complications, mechanism of injury, age, and weight were significant. They were older by an average of 5 years; half of them weighed more than 50 kg and over a half were involved in a road traffic accident. Conclusions: Elastic nailing is a successful tool to treat femoral shaft fractures. Three factors were demonstrated to influence the outcome. The mechanism of injury, age > 11 years, and weight > 50 kg are the most important and are predictors for development of complications such as delayed union or deformity.

A Comparative Study of Management of Femoral Shaft Fracture in Children: A Prospective Study

Context: Femoral shaft fracture is the most common major pediatric orthopedic fractures and treatment of them carries a lot of controversies. Aims: The aim of this study was to compare the functional outcome after internal fixation with titanium elastic nail and stainless steel Kirschner wire in unstable femoral shaft fracture in children. Settings and Design: This prospective study was conducted at Sharda University between December 2010 and December 2017 and were followed up for 12 months. Materials and Methods: A total of hundred children between the ages of 2–14 years having closed unstable fracture of the femoral shaft were included in the present study. Fifty children were managed with titanium nails (Group 1) and the same number of children was managed with stainless steel Kirschner wires (K-wires) (Group 2). Functional outcomes were evaluated using the criteria of Flynn et al. Statistical Analysis Used: Statically analysis was limited to calculation of percentage of patients who had unions, malunions, delayed unions, or nonunions and excellent, good, and poor outcomes. Results: Based on the Flynn criteria, 92% of patients had excellent results, 8% had satisfactory results, and no one showed poor results. There was no clinically significant difference between the two groups with respect to time to union, functional outcome, and complication. Conclusion: The clinic-radiological results were not significantly different between titanium nail and Kirschner wire at 1-year follow-up as observed by our study. The cost of Kirschner wire is one-third the cost of titanium nail.

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.

Frequency of limb shortening in femoral shaft fractures treated by hip spica casting in children in Tertiary Care Hospital.

Objectives: In non-operative methods, hip spica casting is a gold standard for children under six years of age because of excellent bone union and remodeling qualities. The study was conducted to determine the frequency of limb shortening in femur shaft fractures in children treated by hip spica casting. Study Design: Descriptive cross sectional study. Setting: Orthopedics Department of Combined Military Hospital, Rawalakot, Pakistan. Period: One year from July, 2016 to June, 2017. Material and Methods: After approval of the study from institution’s ethical committee, all patients fulfilling the inclusion criteria were admitted through emergency or outpatient department for hip spica casting. It was descriptive cross sectional study and sampling was done by non-probability convenience sampling in 107 femur fracture patients treated by hip spica casting. Diagnosis of the fracture was based upon history of trauma with break in the continuity of shaft as seen by X-ray. Informed consent was obtained from parents/guardian to be included in the study. Results: The mean age was 5(± 2.04) years. Sixty eight percent patients were male and 32% were female. Sixty three percent patients had proximal femoral shaft fracture, 32% had middle femoral shaft fracture and 4% patients had distal femoral shaft fracture. The shortening of limb length was found in14% of patients. Conclusion: In closed femoral shaft fractures, hip spica casting is a safe treatment in children. It has a low risk of complications. We recommend its use except for open fractures, multiple fractures, or fractures in older children.

Results of management of tibia shaft fractures in children with titanium elastic nailing

Results of management of tibia shaft fractures in children with titanium elastic nailing

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.

Treatment of Closed Tibia Shaft Fractures in Children: A Systematic Review and Meta-Analysis.

Tibia fractures are among the most common long-bone fractures in children. Despite this, there is no current consensus on the optimal treatment strategy for closed displaced tibia shaft fractures in the pediatric patient population. The aim of this study is to compare the reported complications and outcomes of reduction and cast immobilization versus flexible intramedullary nailing in the treatment of pediatric tibia shaft fractures. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement when conducting and reporting this prospectively registered systematic review. Eleven studies were included. Quality of the studies was assessed using the Coleman methodology score. Mantel-Haenszel cumulative odds ratios were used to compare the risk of complication between different methods of treatment. Eleven studies including 1,083 patients with diaphyseal fractures of the tibia met the inclusion criteria. The most common fracture type was simple 42-A (782; 91%). Majority (75%) of the patients were treated nonoperatively. The total complication rate was higher among operatively treated patients (24 vs. 9%; p < 0.05). Satisfactory fracture alignment had to be restored surgically in 5% of the primarily nonoperatively treated patients. The evidence levels of the included studies were II (1), III (2), and IV (7). Three-fourths of closed diaphyseal fractures of the tibia in children are still treated with reduction and cast immobilization. Flexible intramedullary nailing is associated with significantly higher complication rate than nonoperative treatment.