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Hanke A, Scheerer-Harbauer E, Wulbrand C, Memmel C. Does Treatment of Adolescent Fractures Differ between Specialties? A Survey among Pediatric and Trauma Surgeons. J Pers Med 2024; 14:842. [PMID: 39202033 PMCID: PMC11355521 DOI: 10.3390/jpm14080842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 07/15/2024] [Accepted: 08/08/2024] [Indexed: 09/03/2024] Open
Abstract
From a traumatological point of view, adolescents (12-18 years) represent a special group of patients. This is due to their biomechanical characteristics being between pediatric and adult fracture types. In Germany, they are treated by both pediatric and trauma surgeons. For this survey, seven cases of adolescent fractures were evaluated by both pediatric and trauma surgeons and their preferred treatment options were raised. The questionnaires were completed anonymously. Additionally, information on the specialty and years of experience were asked. In total, 126 valid questionnaires were obtained (from 78 pediatric and 48 trauma surgeons). The respondents' mean clinical experience was high (71.5% stated more than 10 years of surgical experience). For every single exemplary case, a significant difference in therapy decisions between the groups could be found. For the demonstrated seven cases, a tendency toward more operative and more invasive treatments was found with trauma surgeons compared to pediatric surgeons. On the other hand, there was a risk of underestimating the severity of fracture entities similar to adult fractures in pediatric surgeons. Overall, a continuous interdisciplinary exchange between both surgical specialties is necessary to ensure optimal treatment for adolescent fractures and to develop guidelines in the future.
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Affiliation(s)
- Alexander Hanke
- Department of Pediatric Surgery and Pediatric Orthopedics, Clinic St. Hedwig, Barmherzige Brueder Regensburg, KUNO Pediatric University Medical Center, 93049 Regensburg, Germany; (A.H.)
- Department of Trauma Surgery, Orthopedics and Sports Medicine, Barmherzige Brueder Regensburg, 93049 Regensburg, Germany
| | - Eva Scheerer-Harbauer
- Department of Pediatric Surgery and Pediatric Orthopedics, Clinic St. Hedwig, Barmherzige Brueder Regensburg, KUNO Pediatric University Medical Center, 93049 Regensburg, Germany; (A.H.)
| | - Christian Wulbrand
- Department of Trauma Surgery, Orthopedics and Sports Medicine, Barmherzige Brueder Regensburg, 93049 Regensburg, Germany
| | - Clemens Memmel
- Department of Pediatric Surgery and Pediatric Orthopedics, Clinic St. Hedwig, Barmherzige Brueder Regensburg, KUNO Pediatric University Medical Center, 93049 Regensburg, Germany; (A.H.)
- Department of Trauma Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany
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McGraw-Heinrich JA, Ezeokoli EU, Mitchell P, Silverstein RS, Smith BG. Pediatric distal third tibial shaft fractures: a comparison of surgical fixation methods and incidence of concomitant physeal fractures. J Pediatr Orthop B 2023; 32:393-400. [PMID: 36377938 DOI: 10.1097/bpb.0000000000001038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purposeof this study was to compare outcomes of operatively treated pediatric distal third tibial shaft fractures fixed with elastic nailing or plate fixation and to evaluate the incidence of concurrent distal tibia physeal fractures. Retrospective review identified skeletally immature patients that underwent operative fixation of distal third tibia fractures at a level 1 children's hospital from 2010 to 2020. Patient and fracture characteristics were recorded. Analysis of treatment outcomes was performed and rates of concurrent distal tibia physeal fractures were evaluated. Of the 214 surgically treated tibial shaft fractures, 43 were distal third fractures. A concurrent distal tibia physeal fracture was present in 32.6% of patients. These were significantly associated with spiral distal third tibial shaft fractures. The presence of concurrent physeal fractures did not affect patient treatment outcomes. Comparing elastic nailing versus open reduction and plating revealed no difference with time to fracture union, time of postoperative immobilization, or time to full weight-bearing. While elastic nailing was associated with increased coronal angulation, translation, and shortening of fractures on initial postoperative imaging, there was no difference in rates of malunion at final follow-up. In our series, there were no differences in treatment outcomes based on fixation method. Our operatively treated distal third tibial shaft fractures had a higher rate of associated distal tibial physeal fractures than previously published in the pediatric orthopedic literature. We recommend careful evaluation of the ankle for concurrent physeal injuries in patients with distal third tibial shaft fractures indicated for operative treatment. Level of evidence: level III therapeutic study - retrospective comparative study.
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Affiliation(s)
| | | | | | | | - Brian G Smith
- Baylor College of Medicine, Texas Children's Hospital
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Hanf-Osetek D, Bilski P, Łabądź D, Snela S. Tibial shaft fractures in children: flexible intramedullary nailing in growing children especially weighing 50 kg (110 lbs) or more. J Pediatr Orthop B 2023; 32:253-259. [PMID: 35502744 DOI: 10.1097/bpb.0000000000000986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Currently the gold standard in surgical treatment of displaced tibial shaft fractures in children with open growth cartilage is elastic stable intramedullary nailing (ESIN). The purpose of this study is the analysis of indications, complications, and duration of treatment using intramedullary flexible nails in children who are still growing but especially weighing 50 kg or more. Hospital records from 2017 to 2020 were retrospectively reviewed to identify the children from 4 to 17 years of age with displaced tibial shaft fractures admitted to the hospital. Only children with open growth cartilage, with a minimum of 6 months of follow-up and complete clinical data, were included. Studies of 91 children xwere analyzed. The average patient age at the time of the injury was 10.88 ± 2.82 years. In the entire group, 31.9% children weighed 50 kg or more, and 68.1% of the children were below this weight. All children were treated using ESIN. The mean time to nail removal was 8.4 ± 4.09 months in the whole group of children stabilized with ESIN. There were no differences in the two groups depending on the weight ( P = 0.637). Only two adverse events were observed. This study demonstrates that the use of ESIN in displaced tibial shaft fractures in growing children weighing 50 kg or more is acceptable and safe. The discussion to be made is whether it is still an acceptable method of treatment for this type of fracture due to the progressive obesity epidemic in children and adolescents.
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Affiliation(s)
- Dorota Hanf-Osetek
- Department of Pediatric Orthopedic, Clinical Regional Hospital No. 2
- Institute of Medicine, College for Medical Sciences of University of Rzeszow, Rzeszow, Poland
| | - Paweł Bilski
- Department of Pediatric Orthopedic, Clinical Regional Hospital No. 2
| | - Dawid Łabądź
- Department of Pediatric Orthopedic, Clinical Regional Hospital No. 2
| | - Sławomir Snela
- Department of Pediatric Orthopedic, Clinical Regional Hospital No. 2
- Institute of Medicine, College for Medical Sciences of University of Rzeszow, Rzeszow, Poland
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Çağlar C, Akçaalan S, Bozer M, Akkaya M. Adult Proximal Humeral Locking Plate Is a Good Alternative Option in the Treatment of Adolescent Subtrochanteric Femur Fractures: A Case Series and Literature Review. Hip Pelvis 2022; 34:245-254. [PMID: 36601609 PMCID: PMC9763829 DOI: 10.5371/hp.2022.34.4.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose Management of pediatric subtrochanteric femur fractures (SFFs) is difficult. The aim of this study was to evaluate the outcomes of adolescent SFFs treated with adult proximal humeral locking plates (PHLPs). Materials and Methods A retrospective analysis of 18 adolescents (11 male, 7 female) with a diagnosis of SFF who underwent internal fixation with a PHLP was conducted. Data regarding injury mechanism, fracture pattern, and time to union were recorded for all patients. In addition, a clinical and functional evaluation of patients was performed using the Harris hip score (HHS), Iowa hip score (IHS), modified Merle d'Aubigne-Postel score (MMAPS), Flynn criteria, and hip range of motion (ROM). Results The mean age of the patients was 12.72±2.05 years (range, 10-16 years). Radiological observation was performed for evaluation of five different injury mechanisms and different fracture patterns in patients. The mean postoperative HHS was 92.27±5.61, the mean IHS was 90.88±6.46, and the mean MMAPS was 17.22±0.94. According to the Flynn criteria, excellent results were achieved in 14 cases and satisfactory results were obtained in four cases. Measurements of the patients' mean hip ROM values were as follows: 17.77±3.52° in extension, 115.27±6.74° in flexion, 43.05±3.48° in abduction, 27.50±4.28° in adduction, 42.22±4.60° in internal rotation, and 42.22±3.91° in external rotation. Conclusion Surgery performed on adolescent patients using an adult PHLP showed good, safe results. Therefore, it should be considered as an alternative option.
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Affiliation(s)
- Ceyhun Çağlar
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Serhat Akçaalan
- Department of Orthopedics and Traumatology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Merve Bozer
- Department of Orthopedics and Traumatology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Mustafa Akkaya
- Department of Orthopedics and Traumatology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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ÇAĞLAR C, EMRE F. Clinical and radiographic evaluation of femoral shaft fractures in a pediatric population treated with titanium elastic nails. EGE TIP DERGISI 2021. [DOI: 10.19161/etd.1036963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Zhu D, Xu X, Zhang M, Wang T. Titanium elastic nailing can be used in 6 to 10 years old pediatric with Delbet IV femoral neck fractures. Medicine (Baltimore) 2021; 100:e27588. [PMID: 34713834 PMCID: PMC8556016 DOI: 10.1097/md.0000000000027588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 10/02/2021] [Indexed: 01/05/2023] Open
Abstract
The purpose of this study was to analyze the outcomes of titanium elastic nail (TEN) for the children in 6 to 10 years old who sustained a Delbet IV femoral neck fracture.A total of 56 children aged 6 to 10 years old with Delbet IV femoral neck fracture treated with TEN or cannulated screw (SC) were identified at our hospital from January 2009 to December 2019. Of which 24 were treated with TEN, and 32 with SC. All of them were followed up for 1 year after operation, and the differences in operation time, intraoperative blood loss, hospitalization time, hip joint function, and complication between the 2 groups were compared. Harris and Ratliff hip score were used to evaluate the hip function.All 56 fractures united properly. No major complications were noted in both groups. The intraoperative blood loss and operation time in TEN group and SC group were (11.42 ± 3.41) mL, (19.66 ± 4.05) mL (P = .000) and (33.58 ± 7.89) min, (40.22 ± 7.48) min (P = .002), respectively. There was no significant statistical difference between hip regarding range of motion and femoral neck-shaft angle in both groups, as well as Harris and Ratliff hip score between the 2 groups.TEN represent safe and effective methods in the treatment of Delbet IV femoral neck fracture in 6 to 10 years old children. TEN internal fixation is a minimal invasive and simpler technique and suitable for young children of Delbet IV femoral neck fracture.
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Hong P, Rai S, Liu X, Tang X, Liu R, Li J. Which is the better choice for open tibial shaft fracture in overweight adolescent with open physis: A comparative study of external fixator plus elastic stable intramedullary nail versus external fixator alone. Injury 2021; 52:3161-3165. [PMID: 34246479 DOI: 10.1016/j.injury.2021.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical outcomes of external fixator + elastic stable intramedullary nail (EF+ESIN) vs. external fixator (EF) in the treatment for open tibial shaft fracture in overweight adolescents. METHODS Patients of open tibial shaft fractures younger than 14 years old with body weight over 50 Kg treated with EF + ESIN or EF at our institute from 2010 to 2018 were reviewed. Patients with Gustilo Type III open fractures, pathological fractures, previous fracture or instrumentation in the operative leg were excluded. Baseline information and clinical data were collected from the hospital database and during out-patient visits. RESULTS Forty-six patients, including 27 males and 19 females, were included in the EF group, whereas 35 patients, including 18 males and 17 females, were included in the EF + ESIN group (p = 0.527). The incidence of superficial infection was higher in the EF group (26/46, 56.5%) than the EF + ESIN group (12/35, 34.3%), p < 0.001. The frontal and sagittal angulation was higher in the EF group (p < 0.001), but the degrees in both groups were within the acceptable range. The union time was longer in the EF group (68.0 ± 12.7, d) than the EF + ESIN group (61.9 ± 11.9), p < 0.001. The retaining of EF (11.9 ± 3.2, w) was longer in the EF group than the EF +ESIN group (5.7 ± 1.2, w), p < 0.001. CONCLUSION EF+ESIN is a safe and alternative choice for selected overweight adolescents with open tibial shaft fracture.
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Affiliation(s)
- Pan Hong
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saroj Rai
- Department of Orthopaedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Mahankal, Kathmandu, Nepal
| | - Xiangyang Liu
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Tang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruikang Liu
- First Clinical School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Li
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Miyamoto S, Otsuka M, Hasue F, Fujiyoshi T, Kamiya K, Kiuchi H, Odagiri T, Tanaka T, Nakamura J, Orita S, Ohtori S. Associated injury complicated by pediatric lower limb shaft fractures and clinical efficacy of flexible stainless-steel intramedullary nailing in children less than 15 years old. Orthop Rev (Pavia) 2021; 13:8008. [PMID: 33897986 PMCID: PMC8054656 DOI: 10.4081/or.2021.8008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/05/2021] [Indexed: 11/23/2022] Open
Abstract
Although pediatric lower limb shaft fractures are common, little is known about associated injuries. The purpose of this study was to examine associated injuries complicated by pediatric lower limb shaft fractures and the efficacy of surgical treatment using a flexible stainless-steel intramedullary Ender nail in children less than 15 years old. This is a retrospective review of 29 children younger than 15 years old who were diagnosed with femoral or tibial shaft fractures and treated using Ender nails from 2005 to 2016. Baseline data, etiology, associated injuries, fracture site and patterns, operative and post-operative assessment were evaluated. The average age of the patients was 9.0 years, and mean follow-up was 18.2 months. Eleven patients (79%) had associated injury. At the final follow up, six patients (43%) sustained complications associated with the insertion area of the nail. There was no evidence of deep infection or nonunion at either fracture site. The clinical results were excellent in 10 (67%) fractures, and good in 5 (33%) fractures, based on the modified Flynn criteria. Almost all patients with a femoral fracture had an associated injury including abdominal visceral injury, cerebral contusion or other fractures. This study indicated good clinical and functional outcomes. On the other hand, the minor complications rate was high. Nevertheless, elastic stable intramedullary nailing recently has become available in Japan, and a prospective and comparative study is needed.
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Affiliation(s)
| | | | - Fumio Hasue
- Kimitsu Central Hospital, Kisarazu City, Chiba
| | | | | | | | | | | | - Junichi Nakamura
- Graduate School of Medicine, Chiba University, Chiba City, Chiba
| | - Sumihisa Orita
- Center for Advanced Joint Function and Reconstructive Spine Surgery Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Graduate School of Medicine, Chiba University, Chiba City, Chiba
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Abstract
Objectives
This study aims to investigate the effects of associated factors like age, fracture level, accompanying fibular fractures and wound condition on healing by determining and comparing union scores of pediatric tibial fractures (PTFs). Patients and methods
Forty-five patients with 46 PTFs (32 males, 13 females; mean age 9.5 years; range 2 to 16 years) who were treated by closed reduction and casting or operated between January 2016 and January 2019 were retrospectively evaluated. The union scores were evaluated at the end of fourth, sixth and eighth weeks and compared to each other. Effects of the age, associated fibular fractures, wound condition, fracture level and treatment type to union score were analyzed. Results
Twenty-eight (60.9%) out of 46 PTFs had associated fibular fractures and 18 (39.1%) did not. Motor vehicle accident was the most frequent etiologic factor (47.8%). Thirty-four out of 46 fractures were closed tibial fractures (73.9%) and 12 had open wound (26.1%). There was a negative correlation between age and the union scores (p<0.001 for each week). No significant difference was observed between the union score of diaphyseal and metaphyseal fractures at the fourth, sixth, and eighth weeks. The union scores of each week were higher in the conservative group compared to operative group (p<0.001 for each week). Associated fibular fracture group had lower union scores compared to isolated tibial fracture group at fourth, sixth and eighth weeks. Likewise, the union scores of the open fracture group were lower than the closed fracture group (p<0.05 for each week). Conclusion Associated fibular fractures, open fractures and aging negatively affect union scores of PTFs. Attention should be paid, particularly in these conditions, during the selection of the operation type and the follow-up period of PTFs.
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Chen X, Lu M, Xu W, Wang X, Xue M, Dai J, Zhang Z, Chen G. Treatment of pediatric femoral shaft fractures with elastic stable intramedullary nails versus external fixation: A meta-analysis. Orthop Traumatol Surg Res 2020; 106:1305-1311. [PMID: 33082120 DOI: 10.1016/j.otsr.2020.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND There is currently a debate about whether elastic stable intramedullary nails (ESIN) or external fixation (EF) is the best surgical method for treating pediatric femoral shaft fractures. We performed a meta-analysis to determine which surgical method leads to higher treatment satisfaction, lower complication rates, and reduced treatment time, to investigate whether ESIN is the preferred surgical method for treatment of pediatric femoral shaft fractures. PATIENTS AND METHODS Relevant databases were searched for comparative studies of ESIN versus EF for the treating pediatric femoral shaft fractures. Literature reports and quality evaluations were extracted, followed by a systematic review using RevMan 5.3 software. Treatment satisfaction at the last follow-up, primary complications, secondary complications, and relevant time indicators (operation time, hospital stay, clinical healing time, bone healing time) were analyzed. RESULTS A total of 22 reports were included in this meta-analysis. We found no statistical differences in the treatment satisfaction at the last follow-up between ESIN and EF for the treatment of pediatric femoral shaft fractures. A low rate of postoperative re-fracture (RR=3.58, 95% CI (1.85, 6.92), p=0.0001) and postoperative infection (RR=9.25, 95% CI (5.32, 16.11), p<0.00001), and a high risk of skin irritation (RR=0.15, 95% CI (0.06, 0.37), p<0.00001) were found in the ESIN group. No significant differences between the two approaches were found regarding malunion. A low rate of limb-length discrepancy (RR=2.41, 95% CI (1.40, 4.17), p=0.002), hospitalization (SMD=0.84, 95% CI (0.24, 1.43), p=0.006), clinical healing time (SMD=0.95, 95% CI (0.56, 1.33), p<0.00001) and bone healing time (SMD=0.89, 95% CI (0.39, 1.40), p=0.005) were found in the ESIN group, as compared to that in the EF group. No significant differences were found in fixation failure, activity limitation of the joint, and operation time between the two strategies. DISCUSSION ESIN should be the primary choice for the treatment of pediatric femoral shaft fractures since it has a reliable curative effect and results in a shorter hospital stay, faster fracture healing, and fewer complications. EF is recommended for fractures with serious injury of the soft tissue to avoid intramedullary infection. Double-blind high-quality randomized studies with larger sample sizes are warranted to confirm our conclusions. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Xingguang Chen
- Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, 314000 Jiaxing, China
| | - Minhua Lu
- Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, 314000 Jiaxing, China
| | - Weibin Xu
- Department of Orthopedics, Dushuhu public hospital, 215000 Suzhou, China
| | - Xiaodong Wang
- Department of Orthopedics, Children's Hospital of Soochow University, 215000 Suzhou, China
| | - Mingfeng Xue
- Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, 314000 Jiaxing, China.
| | - Jiaping Dai
- Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, 314000 Jiaxing, China
| | - Zhongwei Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, 314000 Jiaxing, China
| | - Gang Chen
- Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, 314000 Jiaxing, China
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Intraoperative Issues and Clinical and Radiographic Outcomes of Femur Fractures Treated With Flexible Nails: A Comparison of Cases Utilizing Skeletal Traction and a Traction Table to Cases Using Manual Traction Only. J Pediatr Orthop 2020; 40:e676-e682. [PMID: 32118797 DOI: 10.1097/bpo.0000000000001538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The use of the orthopaedic traction table (OTT) during elastic stable intramedullary nailing (ESIN) in the management of displaced diaphyseal femur fractures (DFFs) is still debated. In most centers, children with displaced DFF are treated using an OTT. In some other institutions, however, fracture reduction and stabilization by ESIN are performed on a radiolucent table without an OTT. The aim of this study was to evaluate the clinical and radiologic outcome of children with displaced DFF managed by ESIN with and without the use of an OTT. METHODS Charts and radiographs were retrospectively reviewed for all pediatric patients sustaining DFF managed by ESIN from 2011 to 2017 at 2 different institutions. In all, 69 consecutive children with displaced DFF were recorded, of whom 35 underwent operative treatment by ESIN with the use of an OTT with skeletal traction (Group A), and 34 by ESIN without OTT (Group B). The titanium elastic nails outcome measure scale score and Beaty radiologic criteria were used to evaluate the results. RESULTS Average patient age at time of injury was 9 years (range, 5 to 13) and 10 years (range, 4 to 15) in Groups A and B, respectively. The mean follow-up was 54 months (range, 24 to 96). Overall, complications were observed in 6 patients (8.6%). Complication rate was higher among children managed without OTT (11.8%) than among children treated with OTT (2.5%); no complication related to pin insertion for skeletal traction was recorded. However, the number of patients with a poor outcome according to the titanium elastic nails outcome score was higher in Group A (20%) than in Group B (5.8%). Beaty radiologic criteria were comparable between the 2 groups. Mean length of surgery and mean cumulative time of radiation exposure during surgery were similar between the 2 groups. CONCLUSIONS Overall, both techniques work equally well although patients treated by ESIN with the use of an OTT and skeletal traction tended to have a lower rate of complications and radiologic outcome was worse than for patients treated without using an OTT; however, no statistically significant difference was found.Despite their limitations, the results of this study suggest that displaced DFF can be safely managed by ESIN with or without the use of intraoperative OTT and skeletal traction, according to the surgeon's preference. Further studies are now needed to consolidate these conclusions and clarify the role of the OTT. LEVEL OF EVIDENCE Level III.
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Samelis PV, Papagrigorakis E, Troupis T, Koulouvaris P. Leg Length Discrepancy Due to Loss of Femoral Antecurvatum After Elastic Stable Intramedullary Nailing of Diaphyseal Fractures of the Femur in Children. Cureus 2019; 11:e6343. [PMID: 31938631 PMCID: PMC6952051 DOI: 10.7759/cureus.6343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Limb length discrepancy (LLD) is a frequent complication after elastic stable intramedullary nailing (ESIN) of femoral shaft fractures in children. It is the result of either shortening or lengthening of the affected limb. A shorter limb is usually observed when there is no strict adherence to the main indication of the technique, which is a transverse or short oblique fracture of the diaphysis. A longer limb may be the result of either improper reduction and significant dissociation of fracture fragments, or stimulation of growth of the fractured bone of the child, known as overgrowth. We describe a potential third cause of limb lengthening after treating femoral shaft fractures with the ESIN technique. LLD may be the result of acute femur lengthening due to the loss of normal femoral antecurvatum.
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Affiliation(s)
- Panagiotis V Samelis
- Orthopaedics, Children's General Hospital Panagiotis & Aglaia Kyriakou, Athens, GRC
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Extra-articular proximal femur fractures in children and adolescents treated by elastic stable intramedullary nailing. INTERNATIONAL ORTHOPAEDICS 2019; 43:2849-2856. [PMID: 31352564 DOI: 10.1007/s00264-019-04379-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Extra-articular proximal femur fractures (EPFF) remain challenging for their intrinsic instability. The aim of this study is to evaluate the results of elastic stable intramedullary nailing (ESIN) of extra-articular proximal femur fractures in children and adolescents. METHODS A retrospective monocentric study of children treated by ESIN for EPFF between 2012 and 2018 was conducted. We included all patients sustaining a fracture within 10% of the femur length below the lesser trochanter. Studied data were age, sex, femur length, fracture distance below the lesser trochanter, number of days of hospitalization, time to nail removal, and complications. Beaty's criteria and the titanium elastic nailing (TEN) outcome measure scale were used to evaluate radiologic outcome and assess clinical recovery, respectively. RESULTS A total of 24 cases were reviewed (18 males, 6 females). Mean age was 8.23 years (range 5-13). Mean duration of hospitalization was 3.7 days (range 2-12). Mean time to nail removal was 28 weeks (range 12-53). Malalignment was observed in five patients, but in all cases, angulation did not exceed 10°. No limb length discrepancy was observed. Twenty out of 24 patients had excellent Beaty's radiological and TEN clinical outcome scores. No poor results were observed. CONCLUSIONS The results of our study show that good outcomes following surgical treatment by ESIN should be expected in children younger than 14 years of age with displaced EPFF. Excellent radiological and clinical outcomes were observed in 83.7% of the cases, with a low rate of complications and short hospital stay.
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