Treatment Of Pediatric Femoral Fractures Research Articles

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

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

Waterproof Hip Spica Casts for Pediatric Femur Fractures.

Hip spica casting is the treatment of choice for femur fractures in children ages 6 months to 5 years. Traditional spica (TS) casting utilizes cotton padding that precludes patient bathing. Waterproof (WP) casting has inherent advantages, including clearance for bathing and improved family satisfaction. This study examines the safety and efficacy of WP hip spica casting for the treatment of pediatric femur fractures. This is a retrospective, matched cohort study of patients ≤5 years with a femur fracture treated with hip spica casting. Patients with WP casts were matched to patients with TS casts by age, sex, and fracture type. TS casts utilize a Goretex liner and cotton padding, while WP spicas utilize fully WP materials and can be completely submerged in water. Fifty patients were included (25 WP, 25 TS) without differences between cohorts in age, weight, or sex. There were no differences in operative time, length of stay, or length of time in cast. Patient charges were significantly lower in the WP group ($230 vs. $301, P<0.001). At cast-off, coronal/sagittal alignment and shortening were similar, while 9 TS patients had minor skin and/or cast complications that required outpatient repair versus only 1 WP patient (P<0.001). In a matched comparison, WP spica casting significantly reduces skin and cast complications traditionally associated with cotton-based spica casting, with significantly lower charges for WP cast materials. Fracture healing rate, alignment, and shortening at cast-off are similar in WP versus TS casts. WP spica casting is safe and efficacious for pediatric femur fractures, with the inherent advantage of clearance for bathing. Level 3.

Comparison of Noncontact Plating with Conventional Methods and Osteosynthesis Techniques in the Treatment of Pediatric Femoral Fractures

Introduction: Studies on surgical options in pediatric femoral fractures have been continuing for many years. We aimed to compare the noncontact plating we applied with the other techniques.&#x0D; Material and Methods: Pediatric patients treated for femoral shaft fracture were included. The patients were evaluated in terms of fracture type, time until surgery, duration of surgery, time of union, complications, Flynn criteria, radiological findings. 21 were in the elastic nailing (group 1), 27 were in the conventional plating (group 2), 11 were in the noncontact plating (group 3). &#x0D; Results: The mean age was 8.3±1.4 (6-11) in group 1, 10.2±2.2 (7-15) in group 2, and 9.7±2.8 (7-15) in group 3. The time of union was 8.0±2.2 weeks (6-16) in group 1, 9.7±2.7 weeks (7-20) in group 2, and 7.1±1.0 weeks in group 3 (6 -9). In group 1, one patient had delayed union, two patients had a valgus deformity, two patients had minor wound site infection, and four patients had shortening of less than 2 cm. In group 2, three patients had a valgus deformity.Moreover, one patient underwent revision due to plate fracture. In group 3, no delayed union or deformity was observed in any patient.&#x0D; Conclusion: The fact that elastic nailing, which is the most frequently recommended method in pediatric femoral fractures. However, it is obvious that conditions such as the absence of splinting, better reduction, fewer deformity, early rehabilitation provide advantages over noncontact plating. While it is up to the surgeon's preference, noncontact plating can be applied safely and successfully.

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.

A review of pediatric femoral fracture patterns, surgical managements, and outcomes

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Femoral fractures are the most common pediatric orthopedic fractures that require hospitalization. The non-accidental injury should be suspected in early infancy and non-ambulatory children. Treatment of pediatric femoral fractures is widely variable and depends on intrinsic and extrinsic factors. This study presents pediatric femoral fracture epidemiology and outcomes and reviews the literature regarding best practices in pediatric femoral fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This retrospective study reviewed the clinical and radiological records of forty-sevens femur fractures in the pediatric age group from September 2020 until June 2021 in Prince Rashid bin AL Hassan Military Hospital in Jordan.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Males form 80.9% of patients. The mean age for the patients was equal to 6.70 years (±3.91). Falling is responsible for the majority of the injury. The middle femur shaft was fractured in 46.8%, and the pathological fracture was found in 17% of patients. Non-operative treatment by cast represents 42.6%. All fractures were healed at 7.90 weeks (±2.37).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Pediatric femur fracture lacks standardized treatment. Nevertheless, most fractures healed with satisfactory results. Younger age groups are more likely to be treated non-operatively. Non-surgical treatment is more prone to shortening, angulation, and later return to weight-bearing and activity. Children older than eight years treated by plating demonstrated faster healing, return to full weight-bearing, and lower complication rate. &lt;/p&gt;

Sub muscular bridge plating for pediatric femur fractures – Review of 12 patients

Introduction: The treatment of paediatric femoral fractures has been evolving from nonoperative modalities to operative intervention, especially in older children. Different methods of fixation include flexible intramedullary nailing, modified locked intramedullary nailing, external fixation, open compression plating, and sub muscular bridge plating. Treatment of complex paediatric femur diaphyseal fractures is difficult by conventional methods. External ?xation can lead to malalignment and refractures, casting is difficult for polytrauma patients and larger children, elastic nails do not provide adequate stability to unstable fractures and metaphyseal areas, and lateral trochanteric entry rigid nails are unsuitable for very proximal and distal fragments and are ideal for older children for the want of larger medullary canal. Sub muscular bridge plating has emerged as a viable alternative procedure. We present our results of sub muscular bridge plating in 12 patients. Materials and Methods: We retrospectively reviewed 12 patients with pediatric diaphyseal femoral fractures treated with SBP from 2014 to 2016. The average age was 9 years with follow up of 1yr. Results: All the children had complete union and could return to full activity. Two patients had superficial infections. There were no cases of significant malalignment or leg length discrepancy. Implant removal was performed in 8 patients without complications. Conclusion: We find sub muscular plating of paediatric femoral fractures to be an effective and reliable procedure. SBP is a minimally invasive technique that allows early mobilization with minimal complications. Keywords: Paediatric femur fractures, Submuscular plating.

Epidemiology of pediatric femur fractures in children: the Swedish Fracture Register

BackgroundAlthough femur fractures in children are rare, they are the most common fractures in need of hospitalization. We sought to describe the epidemiology and treatment of pediatric femur fractures recorded in the Swedish Fracture Register (SFR). We also studied the relationship between femur fractures, age, sex, fracture pattern, injury mechanism, seasonal variation and treatment.MethodsThis nationwide observational register study was based on the pediatric part of the SFR. We included all patients < 16 years of age who were registered in the SFR from 2015 to 2018.ResultsOf the 709 femur fractures, 454 (64%) occurred in boys. Sixty-two of these fractures were proximal (9%), 453 shaft (64%) and 194 distal (27%). A bimodal age distribution peak was observed in boys aged 2–3 and 16–19 years. In contrast, the age distribution among girls was evenly distributed. Younger children were mainly injured by a fall, whereas older children sustained their fracture because of traffic accidents. Non-surgical treatment prevailed among younger children; however, prevalence of surgical treatment increased with age.ConclusionsWe found a lower ratio between boys and girls (1.8:1) compared to earlier studies. The bimodal age distribution was seen only in boys. Falls were the most common injury in younger children, whereas traffic-related accidents were the most common in adolescents. With age, there was a corresponding increase in surgical treatment.

Are J-splints Safe and Effective as Definitive Treatment for Pediatric Femur Fractures?

Purpose The current treatment for the majority of femur fractures in patients five years of age and younger is application of a hip spica cast. The J-splint has been shown to be a temporizing treatment that emergency department providers can apply until the child undergoes the hip spica cast placement. The purpose of this study was to determine if J-splints can be utilized as definitive treatment for pediatric femur fractures. Methods A retrospective review …

Are J-splints Safe and Effective as Definitive Treatment for Pediatric Femur Fractures?

Are J-splints Safe and Effective as Definitive Treatment for Pediatric Femur Fractures?

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.

TREATMENT OF PEDIATRIC FEMORAL FRACTURES IN THE CITY OF ZAGREB.

SUMMARYFemur fractures in children can be treated with a number of operative and conservative methods. Numerous factors determine which method is optimal for a specific fracture. The aim of this research was to analyze distribution of femur fractures in children living in the urban communities of Zagreb and Zagreb County by localization, type and frequency of treatment methods used according to age and fracture mechanism. The research included 103 children aged up to 18 years, treated for femur fractures at the Zagreb University Hospital Centre and Zagreb Children’s Hospital. Data were collected from these institutions and a retrospective study covered the 2010-2015 period. The cause of fracture and diagnosis were coded with the help of the International Statistical Classification of Diseases and Related Health Problems. Operative treatment was applied in 55% of cases, which is contrary to previous researches. The highest incidence of femur fractures was recorded in the 0- to 4-year age groups, accounting for 49.1% of all fractures. These fractures mostly occurred due to falls and were more often treated with non-operative methods. All other age groups were mostly treated with operative methods. Coxofemoral immobilization and traction were used as non-operative methods, whereas flexible intramedullary nailing was the most frequently used operative method. The treatment depended on age, complexity of the fracture, fracture type, fragment displacement, and associated injuries. The cause was also an important factor on choosing the treatment method. Non-operative treatment was mostly used for fractures caused by falls (64.71% of cases due to falls) and operative treatment was mostly used for fractures caused by traffic accidents (79.4% of cases due to traffic accidents). It is a wide-known opinion that the best treatment for femur fractures in children is non-operative treatment. However, recent studies have shown that the use of operative methods in femur fracture treatment is growing. Our cohort of children treated during a five-year period (2010-2015) also underwent operative treatment more often than non-operative one. Two non-operative and eight operative methods were used. With such a large number of methods, it is clear that there is no unique method for all fractures. However, it is clear that the trend of using operative treatment is connected to the perennial trend of considerable sociodemographic and socioeconomic changes in urban settings such as Zagreb. Lifestyle changes directly affect the prevalence of femur fractures among children, as well as approach to treatment choice. General opinion is that most of fractures that occur at an early age can be treated with non-operative methods. Our research on femur fractures in children confirmed this rule. The youngest age group that had the highest incidence of fractures (49.1% of all fractures) was treated with non-operative methods in 75% of cases. Operative methods prevailed in other age groups. Similar results have been published by other authors. In conclusion, nearly half of all femur fractures (49.1%) occurred at a young age (0-4 years). Diaphysis fractures were most common. Most of the fractures that occurred during the 2010-2015 period were treated with operative methods, mostly in children aged 5-9 years. Out of eight different operative methods, elastic stable intramedullary osteosynthesis was most frequently used (60%). Coxofemoral immobilization and traction were used as non-operative methods.

Regionalization of Isolated Pediatric Femur Fracture Treatment: Recent Trends Observed Using the Kids' Inpatient Database.

Isolated pediatric femur fractures have historically been treated at local hospitals. Pediatric referral patterns have changed in recent years, diverting patients to high volume centers. The purpose of this investigation was to assess the treatment location of isolated pediatric femur fractures and concomitant trends in length of stay and cost of treatment. A cross-sectional analysis of surgical admissions for femoral shaft fracture was performed using the 2000 to 2012 Kids' Inpatient Database. The primary outcome was hospital location and teaching status. Secondary outcomes included the length of stay and mean hospital charges. Polytrauma patients were excluded. Data were weighted within each study year to produce national estimates. A total of 35,205 pediatric femoral fracture cases met the inclusion criteria. There was a significant shift in the treatment location over time. In 2000, 60.1% of fractures were treated at urban, teaching hospitals increasing to 81.8% in 2012 (P<0.001). Mean length of stay for all hospitals decreased from 2.59 to 1.91 days (P<0.001). Inflation-adjusted total charges increased during the study from $9499 in 2000 to $25,499 in 2012 per episode of treatment (P<0.001). Total charges per hospitalization were ∼$8000 greater at urban, teaching hospitals in 2012. Treatment of isolated pediatric femoral fractures is regionalizing to urban, teaching hospitals. Length of stay has decreased across all institutions. However, the cost of treatment is significantly greater at urban institutions relative to rural hospitals. This trend does not consider patient outcomes but the observed pattern appears to have financial implications. Level III-case series, database study.

Elastic Stable Intramedullary Nailing for Treatment ofPediatric Femoral Fractures; A 15-Year Single Centre Experience.

Objective:To analyze outcomes of treatment and complications in children treated with elastic stable intramedullary nailing (ESIN) due to femoral fracture.Methods:From May 2002 until May 2018 case records of 103 patients (76 male and 27 female), with median age of 9 (range, 3-17) and follow-up of 92 months, who underwent ESIN because of displaced femoral fracture were retrospectively reviewed. The patient’s information including age, sex, side involved, trauma mechanism, type of fracture, associated injuries, neurovascular status, complications, operation time, duration of hospital stay, time to implant removal were analyzed. The surgical procedure implied a reposition of bone fragments and osteosynthesis with titanium elastic nails introduced through an incision over the lateral and medial border of the distal femoral metaphysis. Results:All patients achieved complete radiographic healing at a mean of 8.5 (range, 5-15) weeks. Nine (8.49%) postoperative complications were recorded: three entry site skin irritation, two cases of valgus angulation and one case of nail protrusion, re-fracture, Varus angulation and delayed union. All complications, except case of re-fracture and one valgus angulation, were treated conservatively, with no long term consequences for the patients. Two patients were re-operated. After removal of nails all patients recovered complete function of the extremity, without long term consequences.Conclusion:The ESIN for treatment of femoral fractures shows very good functional and cosmetic results. It allows an early functional and cast-free follow-up with a quick pain reduction. Because of the excellent objective and subjective results, the operative stabilization of femoral fractures with ESIN should be recommended to all pediatrics patients

Financial Analysis of Closed Femur Fractures in 3- to 6-Year-Olds Treated With Immediate Spica Casting Versus Intramedullary Fixation

Health care in America continues to place more importance on providing value-based medicine. Medicare reimbursements are increasingly being tied to this and future policy changes are expected to reinforce these trends. Recent literature has shown pediatric femur fractures in preschool-age children have equivalent clinical and radiographic outcomes when treated with spica casting or flexible intramedullary nails (IMN). We compared hospital care statistics including charges for nonoperative versus operative treatment for closed femur fractures in 3- to 6-year-olds. An IRB-approved retrospective chart review was performed of 73 consecutive 3- to 6-year-olds treated at a regional level 1 pediatric hospital from January 1, 2009 to December 31, 2013 with an isolated, closed femoral shaft fracture. Exclusion criteria included open fractures, bilateral injury, and polytrauma. Immediate spica casting was performed in the Emergency Department or Anesthesia Procedure Unit versus IMN in the operating room. A total of 41 patients were treated with spica casting and 32 patients were treated operatively with flexible IMNs; 3 patients failed nonoperative care. After analysis of final treatment groups, significant differences included age at injury: 3.7 years for cast versus 5.3 years for IMN (P<0.001), time to discharge 21 versus 41 hours (P<0.001), 3.2 versus 4.4 clinic visits (P<0.001), follow-up 3.5 versus 9.4 months (P<0.001). Orthopedic surgeon charges were $1500 for casted patients versus $5500 for IMN (P<0.001). Total hospital charges were $19,200 for cast versus $59,700 for IMN (P<0.001). No difference was found between clinic charges or number of radiographs between groups. In total, 76% of cast group were discharged <24 hours from admission versus 8.6% in operative group. In the operative group, 83% had implant removal with no statistically significant charge difference between those who had implant removal versus retention. Treatment of pediatric femur fractures in 3- to 6-year-olds with IMN is associated with longer hospital stays, significantly greater hospital charges, longer follow-up and more clinic visits compared with spica casting. These findings are at odds with previous literature showing shorter hospital stays and decreased cost with nailing compared to traction and casting. This shows a clear difference between 2 treatments that yield similar clinical and radiographic outcomes. Level III-retrospective comparative study.

A Quartet of Elastic Stable Intramedullary Nails for More Challenging Pediatric Femur Fractures.

The insertion of 2 elastic stable intramedullary nails (ESINs) is a common treatment for pediatric femur fractures. However, the use of this technique in length-unstable or metadiaphyseal fractures has historically been associated with higher complication rates. To improve stability, the addition of a third ESIN has been assessed biomechanically and clinically, but the addition of a fourth nail has only been evaluated biomechanically. The purpose of this study is to report our surgical technique and radiographic outcomes using a quartet of ESINs in pediatric femur fractures. A retrospective review was performed of pediatric patients with length-unstable or metadiaphyseal femur fractures who were treated with 4 ESINs by a single surgeon from 2008 to 2013. Nails were inserted in a retrograde manner, 2 each from medial and lateral starting points. Patients were followed clinically and radiographically until the union and routine removal of hardware. Primary outcomes included fracture union, sagittal, and coronal plane alignment, and complications. Fourteen patients underwent quartet ESIN placement. Two patients were excluded: one for early loss to follow-up and another with a diagnosis of osteogenesis imperfecta. The average patient age was 9.3 years (range, 4 to 14 y) and weight was 47 kg (range, 21 to 95 kg). All fractures achieved radiographic union at mean 5.5 months (range, 2 to 9 mo). Hardware was removed at a mean of 9.4 months (range, 2 to 22 mo) following implantation. At final mean follow-up of 18 months, patients and families reported no functional limitations. There were no hardware failures or revision surgeries. There were no limb length discrepancies or malalignment at the time of final radiographic follow-up. There were 2 minor complications-1 patient with pain secondary to nail migration resulting in prominence at the knee and another with refracture following a fall. The stable refracture occurred before complete fracture union and hardware removal and went on to the union without the need for any additional treatment. Treatment with a quartet of ESINs should be considered for skeletally immature children with length-unstable or metadiaphyseal femur fractures. In this series, all fractures achieved union without major complications or hardware failure. This modification to traditional elastic nailing techniques is an option for the surgeon to consider as an alternative to rigid intramedullary nailing, submuscular plating, or external fixation. Level IV.

Locking plate fixation in pediatric femur fracture: evaluation of the outcomes in our experience.

Background and Aim: Femoral shaft fracture is a common traumatic musculoskeletal injures in pediatric population. The treatment of diaphyseal femoral fractures depends on age patient and pattern fracture. We present our record about the use of locking plate fixation and their outcomes. Method: We conduct a retrospective analysis in 22 patients, surgically treated for 26 diaphyseal femur fracture between 2008 and 2013. The mean age was 13 years. All the patients underwent a clinical and radiological follow-up for two years. We recorded time to weight bearing, time to union, complication (malalignment, dysmetria, infection), time to resumption to sport, plate removal, parents’ satisfaction. Results: All the patients had a minimal clinical e radiological follow-up of 24 months. The average fracture healing time was of 7.4 weeks. All the patients had a full hip and knee range of movements. Fifteen patients developed minor malalignment (varo-valgus or procurvatum femur) without clinical effects. No cases of infections. The mean time to a full weight bearing was 12 weeks and the return to sportive activity was 24 weeks. Four patients required a plate and screws removal. The average result of parents’ satisfaction was 8/10. Conclusions: Locking plate fixation is to be considered a successful way of treatment for pediatric femur fractures, especially in patients older than 6 years, head-injured or in the treatment of polytrauma. The anatomic and functional outcomes are comparable to those of other fixation techniques for this kind of fracture. (www.actabiomedica.it)

Comparison of rush pins with titanium elastic nails for treatment of pediatric femoral shaft fractures

Background: Pediatric femoral shaft fracture accounts for 1-2% of all pediatric fractures. Closed reduction and internal fixation with intramedullary devices is the treatment of choice for children older than 4 years. However, antegrade intramedullary devices are associated with concerns regarding possibility of injury to the vascular supply of the proximal femur. Therefore, retrograde titanium elastic nails (TENs) have become increasingly popular in recent years. Purpose: The purpose of this study was to compare the clinical outcomes of children with femoral shaft fractures treated with antegrade Rush pin and retrograde TENs. Methods: After obtaining the approval of the review board, we retrospectively reviewed the charts of 61 children who presented with femoral shaft fractures between 1991 and 2010. Thirty-eight boys and 23 girls (mean age: 8.8 years) were studied. Thirty-two children were treated with a Rush pin and the other 29 children with TENs. The radiographic and clinical outcomes were compared between the two groups. Results: The coronal alignment of the femur was not significantly different between the two groups (2.46° vs. 1.07°, p = 0.16). However, the sagittal bowing is significantly greater in children treated with TENs (1.2° vs. 7.7°, p ＜ 0.001). Leg length discrepancy is 2.4mm and 2.7mm longer than the uninjured side in Rush pin and TENs group respectively (p = 0.85). No femoral head osteonecrosis or proximal femoral deformity was revealed on the final radiographs. The clinical outcomes were comparable between the two groups. Conclusion: The outcomes in the children treated with a Rush pin inserted through the tip of the greater trochanter were not inferior to those treated with TENs. Therefore, the Rush pin may continue to be an alternative device if the TENs are not affordable or not available in medical facilities.

Variable angle locking plate for treatment of the pediatric subtrochanteric femoral fractures

Objective To explore the clinical effects of variable angle locking plate (VLP) in the treatment of pediatric subtrochanteric femoral fractures. Methods Between January 2012 and November 2014, 9 pre-school children were treated at our department for subtrochanteric femoral fractures. They were 6 boys and 3 girls, with an average age of 4.8 years (from 4 to 6 years). By the Seinsheimer classification, 5 cases were of type ⅡB and 2 of type ⅡC and 2 of type ⅢA. The intervals between injury and surgery averaged 3 days (from 2 to 5 days). All of them were treated with open reduction and VLP internal fixation. Results All the wounds healed well without any infection. All the stitches were removed within 12 days. They were followed up for 8 to 26 months (average, 16 months). All the fractures united within 3 months after operation. Follow-ups revealed no plate or screw loosening, or refracture at the same site. According to the Beaty imaging criteria, the early outcomes were all satisfactory. At the final follow-ups, all the children gained normal gait after full-weight rehabilitation. The affected and normal hips are nearly identical in range of motion and muscle strength. All the children recovered their pre-injury status. By the Sanders scoring for function of the affected hip, 7 cases were rated as excellent and 2 as good. Conclusion VLP can be an effective option for treatment of subtrochanteric femoral fractures in preschool children patients. Key words: Femoral fractures; Fracture fixation, internal; Bone plates; Children