1
|
Beume JS, Schmittenbecher PP. [Shaft fractures of the lower limb in adolescents]. Unfallchirurg 2022; 125:479-491. [PMID: 35522269 DOI: 10.1007/s00113-022-01184-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Abstract
Shaft fractures of the lower extremities are rare during adolescence. Conservative treatment is no longer used for the upper leg and the significance is declining for the lower leg, as only minor axis deviations and malrotations of the shaft are acceptable and conservative therapy is associated with severe impairments in the daily routine; however, conservative treatment is still an option for femoral fractures in children < 3 years of age and for stable fractures of the lower leg. Various osteosynthesis procedures can be used depending on the body weight and epiphyseal maturation. Elastic stable intramedullary nailing is the first choice, followed by solid adolescent femoral or tibial nailing for higher body weights and external fixation for open or multifragmentary fractures. Plate osteosynthesis is an established alternative. Following correct surgical treatment, all fractures have movement and at least partial load-bearing stability and the results are satisfactory. Regular controls are recommended up to the end of the growth period.
Collapse
Affiliation(s)
- Jan-Sebastian Beume
- Kinderchirurgische Klinik, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
| | - Peter P Schmittenbecher
- Kinderchirurgische Klinik, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland.
| |
Collapse
|
2
|
Weber B, Kalbitz M, Baur M, Braun CK, Zwingmann J, Pressmar J. Lower Leg Fractures in Children and Adolescents-Comparison of Conservative vs. ECMES Treatment. Front Pediatr 2021; 9:597870. [PMID: 33748039 PMCID: PMC7969713 DOI: 10.3389/fped.2021.597870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/11/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Lower leg fractures are one of the most common fractures in pediatric age. In general, treatment of lower leg fractures is predominantly non-operative, requiring clinical and radiological controls. Nevertheless, it can be observed that in recent years tibial shaft fractures have increasingly been treated surgically. The aim of the present study is to investigate treatment strategies in the context of different fracture types of the lower leg. Methods: In this retrospective chart review, we analyzed 168 children with a diaphyseal fracture of the lower leg admitted to a trauma center between 2005 and 2017. The fractures were classified according to the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO-PCCF). Results: The frequency of fractures based on the AO-PCCF classification was as follows: Simple oblique fracture of the tibia (43.5%, n = 73), hereof 32 toddler's fractures, multifragmentary oblique fracture of the tibia in 14.3% (n = 24) and simple oblique fracture of both, tibia and fibula in 18 patients (10.7%). Most pediatric fractures were treated conservatively by cast (n = 125). Thirty-seven patients received an ECMES, whereas 3 patients were treated with an external fixator and also 3 fractures were stabilized by plate osteosynthesis. Conservatively treated patients were significantly younger (mean age 6.0) compared to patients treated with ECMES (mean age 10.2) or plate osteosynthesis (PO)/external fixator (EF) (mean age 11.3), even if toddler's fractures (mean age 2.0) are excluded (mean age 7.4). There was no difference in time to full weight-bearing, hospitalization of patients treated with ECMES compared to conservative therapy although ECMES-treated fractures show more instability. The consolidation time was significantly higher in ECMES treated patients compared to conservative therapy. Conclusion: Pediatric patients (≤4 years) with lower leg fractures most often showed simple oblique fractures of the tibia, half of them toddler's fractures, which were treated predominantly by conservative therapy. All in all, the consolidation time was longer in intramedullary nailing (ECMES) than in conservative therapy. Nevertheless, time to full weight bearing and duration of cast was the same in both groups, even though ECMES treated fractures show more instability.
Collapse
Affiliation(s)
- Birte Weber
- Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany.,Department of Trauma, Hand and Reconstructive Surgery, Goethe University of Frankfurt, Frankfurt, Germany
| | - Miriam Kalbitz
- Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - Meike Baur
- Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - Christian Karl Braun
- Institute of Clinical and Experimental Trauma-Immunology, University Hospital of Ulm, Ulm, Germany.,Department of Pediatrics, University Medical Center Ulm, Ulm, Germany
| | - Jörn Zwingmann
- Department of Orthopedic and Trauma Surgery, University of Freiburg Medical Center, Freiburg, Germany
| | - Jochen Pressmar
- Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| |
Collapse
|