EPIDEMIOLOGICAL STUDY OF CHILDREN DIAPHYSEAL FEMORAL FRACTURES

TREATMENT OF PEDIATRIC FEMUR FRACTURES WITH FLEXIBLE STAINLESS STEEL INTRAMEDULLARY NAIL

OBJECTIVES

To identify the characteristics of patients and femur fractures treated with a stainless steel intramedullary nail (ESIN) in children under 15 years of age. Know the results of using the ESIN of related steel in the service.

METHODS

Retrospective study with review of hospital records and organization of data in spreadsheets.

RESULT

24 cases were identified, 17 male cases and 7 female cases. A minimum age of 4 years and a maximum of 11 years were observed (average of 7 years). The 3 most common trauma mechanisms were being run over (n:8, 33%) and falling from a height (n:8, 3%). The most common location of the fractures was in the mid-diaphyseal region (n: 20, 88%), only one case presented a bilateral femur fracture. The most common associated trauma was traumatic brain injury. The observation period observed several months between 2 and 5. With regard to complications, 3 cases were observed (12.5%) being bursitis, vicious construction and loss of reduction.

CONCLUSION

Steel HIF shows similar good results. As the study includes the retrospective profile, the absence of a group and the small sample size. Level of Evidence IV, Case series.

Epidemiology and associated injuries in paediatric diaphyseal femur fractures treated at a limited resource zonal referral hospital in northern Tanzania

Background

Diaphyseal femur fractures contribute up to 40% of paediatric orthopaedic admissions with the World Health Organisation data showing youth are particularly vulnerable and road traffic injuries are the leading cause of death for children and young adults. Different mechanisms results to these injuries and they vary with age and geographical location of the patient. Understanding the incidence, mechanism and pattern of these injuries allows planning for preventive measures and treatment to meet modern day patient demands, generation of appropriate and timely protocols with minimum social and economic burden to the patient and family.

Objectives and methods

A hospital based cross sectional study was conducted using the orthopaedic department patient registry among children aged under 18 years admitted from 2014—2018. Our research question was to determine the epidemiology of diaphyseal femur fractures and coexisting associated injuries among admitted paediatric orthopaedic patients. Patient files were reviewed from the medical records department and a data collecting sheet was used to record demographics and injury data. Odds ratios with 95% confidence intervals for associated injuries in paediatric diaphyseal femur fractures were estimated using multivariable logistic regression model.

Results

We found the prevalence of diaphyseal femur fracture among paediatric orthopaedic admissions was 18% with the majority 111 (68.5%) being males. The leading injury mechanism was a fall (57.4%) followed by road traffic injuries (35.8%) out of which 48.3% resulted from pedestrian vs motorcycle accidents. Traumatic brain injury (TBI) was the most common associated injuries accounting for 69% of these injuries with the majority 79% occurring in patients aged 6 years and older. With age specific analysis, children in 6–12 years and 13–18 years age groups, had 8 and 11 times higher odds for associated injuries (OR 8.25, 95% CI, 1.04—65.31) p = 0.046 and (OR 10.54, 95% CI, 1.26—88.31) p = 0.031 respectively compared to those younger ≤ 2 years. Road traffic related injuries had 17 times higher odds of associated injuries when compared to fall (OR 16.73, 95% CI, 6.28—44.57) p < 0.001. 112 (69.1%) of femur fractures were treated by non-operative method out of this 90 (55.6%) by traction with delayed Spica application. The overall mean duration of hospital stay was 18.5 ± 11 days.

Conclusion

Pedestrian vs motorcycle injuries was the leading specific cause of paediatric diaphyseal femur fractures with TBI being the common associated injury. Non-operative management was the most utilized treatment plan and contributed to ten times higher odds for a longer duration of hospital stay. Initiatives to insure children safety on roads should be strengthened in order to reduce/eliminate this burden. Application and practice of current evidence based clinical guidelines and recommendations is paramount for timely and appropriate treatment of these injuries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05320-x.

Poor prognostic factors of femoral shaft fractures in children treated by elastic intramedullary nailing

Introduction: Femoral shaft fractures in pediatric patients are treated by elastic intramedullary nailing using titanium or stainless-steel nails. The elastic stable intramedullary nailing behaves as an internal splint, promoting early mobilization. This type of treatment involves a minimally invasive approach, no damage to the growth plates, and no impairment of femoral head blood supply. Purpose: The aim of our study was to identify the negative predicting factors that might lead to an increased complication rate after elastic stable intramedullary nailing of femoral shaft fractures in children. Methods: We conducted a retrospective study on 137 patients with femoral shaft fractures treated by elastic stable intramedullary nailing. Patients’ age ranged between 4 and 17 years. We used data from the medical records of the patients to evaluate postoperative complications. Plain radiographs were analyzed to determine the fracture type, fracture location, and postoperative complications such as delayed union, angular deformities, and limb length discrepancies. Multivariate analysis was conducted to identify predictors for poor outcomes. Results: Complications occurred in 29 patients (21%) and consisted of delayed union, axial deformities, or lower limb length discrepancies. In the group of patients that suffered from complications, mechanism of injury, age, and weight were significant. They were older by an average of 5 years; half of them weighed more than 50 kg and over a half were involved in a road traffic accident. Conclusions: Elastic nailing is a successful tool to treat femoral shaft fractures. Three factors were demonstrated to influence the outcome. The mechanism of injury, age > 11 years, and weight > 50 kg are the most important and are predictors for development of complications such as delayed union or deformity.

A Prospective Cohort Study of the Therapeutic Patterns, Challenges and Outcomes of Paediatric Femoral Fractures in a Cameroonian Tertiary Center

BACKGROUND

Knowledge of the therapeutic patterns, challenges and outcomes of treatment of paediatric femoral fractures (PFF) helps to better choose the ideal therapeutic modality which is still controversial. However, this data is scarce in the sub-Saharan African literature.

OBJECTIVE

To determine the therapeutic patterns, treatment challenges and outcomes of treatment of PFF in a tertiary care centre in Cameroon.

METHOD

We conducted a prospective cohort study of all consenting consecutive cases of femoral fractures in patients younger than 16 years managed between 2011 and 2015 at the surgical unit of Yaoundé University Teaching Hospital, Cameroon. We analysed demographic data, injury characteristics, fracture patterns, treatment details, therapeutic challenges and outcomes of treatment at 12 months using Flynn's criteria.

RESULTS

We enrolled 30 femoral fractures from 29 children with mean age was 4.2 ± 3.3 years. The male gender, diaphyseal locations and spiral fracture lines were predominant. Main mechanisms of injury were accidental falls, road traffic accidents and game injuries. Fracture management entailed 12 tractions followed by casting, 10 casting alone, four closed reductions followed by casting, two cannulated screw fixations, one pin fixation and one external fixation. The mean duration of consolidation was 10.3 ± 3.9 weeks. The outcome was rated excellent in 28 cases. Limited resources precluded fluoroscopy use, proper anaesthetic management, early rehabilitation and patient-parent satisfaction.

CONCLUSION

Conservative management of PFF yields a good outcome in our setting. However, an improvement in surgical, radiology and anaesthetic infrastructure is needed for optimal PFF care.