Pediatric femoral shaft fractures: treatment strategies according to age - 13 years of experience in one medical center

Journal of Orthopaedic Surgery and Research

Uri Givon²  Amos Schindler¹  Nir Sher-Lurie²  Oded Hershkovich¹  Yaron Sela¹ 

[1]Department of Orthopedic Surgery, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel

[2]Department of Pediatric Orthopedics, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel

关键词: Children;    External fixation;    Antegrade trochanteric nail;    Plating;    Flexible nails;    Casting;    Traction;    Spica;    Femoral shaft fracture;   

Others  :  817691
DOI  :  10.1186/1749-799X-8-23

 received in 2012-07-01, accepted in 2013-07-04,  发布年份 2013

【 摘 要 】

Objective

The objective of this study was to analyze our experience in treating femoral shaft fractures with different strategies, focusing on the first year after injury when the choice of method would have the greatest impact.

Methods

We reviewed the medical records of all children treated for femoral shaft fractures in our institution between 1997 and 2010. They were divided according to therapeutic approach: spica cast, skin traction, titanium elastic nail (TEN), external fixator, intramedullary medullary nail (IMN), and plating.

Results

The 212 patients included 150 boys and 62 girls (M/F ratio 2.4:1, mean age 5 years, range 0–16). The postoperative radiographic results demonstrated solid union in all patients, with no malunions. Of the 151 children in the spica cast group, 10 required re-manipulation and casting due to loss of reduction with unaccepted angulation, 10 had contact dermatitis, and 2 had fever and pressure sores. All 21 elastic nail group children underwent re-operation to remove the hardware: 3 had soft tissue irritation at the insertion points, and 3 had leg length discrepancy (LLD). Of the 14 external fixation patients, 4 had LLD, 1 had a pin tract infection, and 1 had a fracture through a pinhole after a fall. There were no complications in the 12 IMN patients, the 3 plating patients, or the 11 skin traction patients. LLD rates in the spica group were 10.5% higher compared to those in the control group (other treatment modalities) (P = .03).

Conclusions

TEN treatment was superior to spica casting for children who had reached an average age of 4 years.

【 授权许可】

   
2013 Sela et al.; licensee BioMed Central Ltd.

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