Interventions for treating femoral shaft fractures in children and adolescents (original) (raw)
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Outcome of non-operative management of femoral shaft fractures in children
African Journal of Paediatric Surgery, 2011
Background: Femoral shaft fractures are common injuries in childhood. There is paucity of information on their presentation and outcome of the available treatment methods in the African population. This study evaluated the outcome of non-operative methods of treatment of femoral shaft fractures in our centre. Patients and Methods: A retrospective review of the database of children aged 14 years and below with femoral shaft fractures treated nonoperatively over a 10-year period. Results: A total of 134 patients with 138 fractures met the study criteria. This consisted of 71 boys (mean age = 6.1 years ± SD) and 63 girls (mean age = 6.5 years ± SD). Pedestrian vehicular accident was the most common cause of femoral shaft fractures in the study population. The midshaft was the most common site of fractures. There were associated injuries to other parts of the body (especially head injury) in 34.3% of the patients. The commonest mode of treatment was skin traction only (87.7%). The mean time to fracture union was 4.9 weeks ± SD (range = 3-15 weeks). The mean length of hospitalisation was 6.7 weeks ± SD (range = 5 days-11 weeks). There was a fairly strong positive correlation between the length of hospitalisation and the presence of associated injuries, especially head injury, upper limb fractures and bilaterality of the fractures. The mean total cost of treatment was #7685 (Naira) or 51.2(range=51.2 (range = 51.2(range=14.2-$190). At the last follow up, 97.8% of the fractures united without significant angulation or shortening. Conclusion: The outcome of non-operative treatment of femoral shaft fractures in our setting is comparable to the results of other workers. Methods of treatment that shorten the length of hospitalisation without unduly increasing cost should be encouraged.
Journal of Orthopaedic Surgery and Research, 2013
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).
Femoral fractures are among common injuries in the paediatric age group treated by an orthopaedic surgeon. In the last two decades there was an increased interest in the operative treatment of paediatric fractures. Controversy persists regarding the age between 0 to 12 years 3 So we performed a study to find out whether conservative management is justified in paediatric patients with femoral shaft fractures or not. This was a prospective interventional study in which all children between 0-12 years of age with diaphyseal fractures of femur admitted in department of orthopaedics, RIMS hospital, Imphal-were included in the study. The study was conducted from September 2014 to August 2016. The aim of our study was to evaluate the functional outcome after traction and hip spica application in diaphyseal femoral fractures between 0 to 12 years. In our study a total of 30 cases were included and the final outcome was excellent in 20 cases, satisfactory in 9 cases and there was one patient had poor outcome.
Algorithm for the management of femoral shaft fractures in children
Musculoskeletal surgery, 2014
Pediatric closed femoral shaft fractures are commonly related to a good prognosis. There is no consensus on treatment. We aimed to evaluate the treatment, features, radiological findings and management strategies, creating an algorithm of treatment. Fifty-two simple femoral shaft fractures in children were retrospectively evaluated for age and gender distribution, side of the fracture, etiology of injuries, limb length discrepancy, range of knee and hip motion and parents satisfaction with a mean clinical and radiographic follow-up of 3 years and 6 months. Twenty-eight patients were treated with reduction and early hip spica cast while 24 patients were treated with external fixation (EF). Nearly 58 % of the cases were caused by traffic accidents and were predominantly male (61.5 %). Most of the fractures were of the middle femoral shaft (57.6 %). Muscle strength was normal (MRC scale) in all patients with no pain (NIPS and PRS scale). Knee and Hip range of motion were similar in bot...
Elastic Stable Intramedullary Nailing Femoral Shaft Fractures in Children from Six to Ten Years Age
The Egyptian Journal of Hospital Medicine, 2021
Background: Diaphyseal fractures of the femur (DFF) are common long-bone injuries in children and adolescents. DFF represent 1.5% of fractures in childhood. Objective: This study aimed to evaluate the clinical, functional and radiological outcome of femoral shaft fractures, which are managed by elastic stable intramedullary nailing (ESIN) in pediatric age 6-10 years. Patients and Methods: A prospective clinical randomized trial study was conducted on18 children underwent elastic stable intramedullary nailing (ESIN) for treating femoral shaft fractures at Orthopedic department, Zagazig University Hospitals during the period from April to December 2020. Plain X-rays of the femur Antero-posterior (AP) & Lateral (Lat.) views (from hip to the knee joint) was taken. Results: The time to surgery was 1.39 ± 1.12 days ranging from 1 to 6 days, the time till full union was 9.4 ± 1.76 weeks ranging from 7 to 12 weeks, more than half of the studied group (55.5%) ranged from 7 to 9 weeks and the time of full weight bearing was 9.6 ± 1.7 weeks ranging from 7 to 12 weeks, half of the studied group (50.0%) ranged from 7 to 9 weeks. So, the final outcome was 83.3% had excellent functional outcome, 11.1% of them had satisfactory functional outcome and 5.6% had poor functional outcome. 88.8% didn't have any complications, 5.6% of them had irritation and 5.6% had superficial infection. Conclusion: ESIN is the choice treatment for transverse and short oblique shaft fractures in patients aging from 6 to 10 years old.
2008
Objective: There is no consensus on treatment of closed femoral shaft fractures in children 6-12 years old .The aim of this study was to evaluate and compare the short term results of pediatric femoral shaft fractures at above ages with two different methods of treatment: skeletal traction followed by a hip spica cast and surgical treatment by intramedullary pin fixation and to determine which of these methods results in earlier union of fracture and independent ambulation of the patients. Methodology: This study was performed prospectively at two hospitals during a period of 32 months from 2003 through 2006. Sixty six children with closed fractures of the femoral shaft were treated and followed at least through the time of fracture healing, spica cast removal and onset of unprotected walking in two separate groups: (A) skeletal traction by 90 – 90 technique followed by spica cast (n=30), (B) open reduction and internal fixation with intramedullary pin and cast (n=36). The length of...
The clinical features, management options and complications of paediatric femoral fractures
European Journal of Orthopaedic Surgery & Traumatology, 2021
This article discusses the incidence, applied anatomy and classification of paediatric femoral fractures based on critical appraisal of the available evidence. The aim is to identify techniques that are relevant to contemporary practice whilst excluding the technical details of individual procedures that are beyond the scope of this review. Injuries of the proximal, diaphyseal and distal segments are considered individually as there are considerations that are specific to each anatomical site. Femoral neck fractures are rare injuries and require prompt anatomical reduction and stable fixation to minimise the potentially devastating consequences of avascular necrosis. Diaphyseal fractures are relatively common, and there is a spectrum of management options that depend on patient age and size. Distal femoral fractures often involve the physis, which contributes up to 70% of femoral length. Growth arrest is common consequence of fractures in this region, resulting in angular and length...