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Tekin SB, Karabulut Ç, Bozgeyik B, Bahadir Gökçen H. Treatment of pediatric femur supracondylar fractures: comparison of K-wire fixation versus plate-screw fixation. J Pediatr Orthop B 2024; 33:70-75. [PMID: 37040655 DOI: 10.1097/bpb.0000000000001086] [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: 04/13/2023]
Abstract
This study aims to compare the clinical and radiological results of patients who underwent plate-screw fixation and K-wire fixation in supracondylar femur fractures in the pediatric population. Patients aged 5-14 years suffering from supracondylar femoral fractures who underwent K-wire and plate-screw fixation were included in the study. Of all patients, follow-up period, age, fracture union time, gender, leg length discrepancy, and Knee Society Score (KSS) data were analyzed. The patients were divided into two groups; fixation with plate (Group A) and fixation with K-wires (Group B). Forty-two patients participated in the study. There was no significant difference between the two groups in terms of age, gender, and follow-up time ( P > 0.05). When comparing the KSS results, no statistically significant difference was found between the two groups ( P = 0.612). A statistically significant difference was detected between the two groups regarding union time ( P = 0.01). When both groups were analyzed, no significant difference was found between the two groups in terms of functional results. Good results can be obtained in both plate-screw and K-wires in pediatric supracondylar femur fractures.
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Affiliation(s)
| | - Çağri Karabulut
- Department of Orthopedic Surgery, Gaziantep University, Gaziantep
| | - Bahri Bozgeyik
- Department of Orthopedic Surgery, Kadirli State Hospital, Kadirli
| | - H Bahadir Gökçen
- Department of Orthopedic Surgery, Istinye University Liv Hospital Ulus, Istanbul, Turkey
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Valenza WR, Soni JF, Bodanese BHS, Rossetto DM, Kosovits FGDEP, Cordeiro PIP. PROXIMAL HUMERAL LOCKING PLATE: A VIABLE ALTERNATIVE FOR FIXATION OF DISTAL FEMORAL FRACTURES IN CHILDREN. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e262167. [PMID: 37323152 PMCID: PMC10263410 DOI: 10.1590/1413-785220233102e262167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/09/2022] [Indexed: 06/17/2023]
Abstract
Distal femoral metaphyseal fractures are rare in children, and the proximity of the fracture to the growth plate makes their approach challenging. Objective Evaluate outcomes and complications of treatment of distal femoral metaphyseal fractures in children with proximal humeral locking plates. Method Retrospective study between 2018 and 2021, including seven patients. The analysis included general characteristics, trauma mechanism, classification, clinical and radiographic outcomes, and complications. Results The mean follow-up was 20 months, the average age was nine years, five patients were boys, and six fractured on the right side. Five fractures were caused by car accidents, one by falling from their own height and one by playing soccer. Five fractures were classified as 33-M/3.2 and two as 33-M/3.1. Three fractures were open, Gustilo IIIA. All seven patients recovered mobility and resumed their pre-trauma activities. All seven healed, and one fracture was reduced to 5 degrees valgus, without any other complications. Six patients had the implant removed and did not present refracture. Conclusion Treatment of distal femoral metaphyseal fractures with proximal humeral locking plates is a viable option that offers good results and fewer complications, saving the epiphyseal cartilage. Level of Evidence II; Controlled study without randomization.
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Affiliation(s)
- Weverley Rubele Valenza
- . Hospital do Trabalhador de Curitiba, Curitiba, PR, Brazil
- . Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brazil
| | - Jamil Faissal Soni
- . Hospital do Trabalhador de Curitiba, Curitiba, PR, Brazil
- . Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brazil
| | | | | | | | - Pedro Ivo Pedroni Cordeiro
- . Hospital do Trabalhador de Curitiba, Curitiba, PR, Brazil
- . Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brazil
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Bakhsh K, Zimri FK, Mohammad E, Atiq-Ur-Rehman, Saaiq M. Presentation and outcome of femoral infected non-unions in children and adolescents. Pak J Med Sci 2020; 37:201-205. [PMID: 33437277 PMCID: PMC7794135 DOI: 10.12669/pjms.37.1.3354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives To document the presentation of infected non-unions of femur in pediatric and adolescent population and evaluate the outcome of segmental bone transport with the Ilizarov method. Methods This prospective case series study was carried out over a period of five years, from January 01, 2015 to December 31, 2019. The study included all children and adolescent patients who presented with femoral infected non unions. The study excluded patients above the age of 16 years and those who had pathological fractures secondary to bone pathologies such as cysts, tumors or metabolic bone diseases. Results Out of 31 patients, 27(87.09%) were males and 4(12.90%) were females. The mean age was 13.48±1.98 years. The underlying mechanisms that lead to the causation of fractures included road traffic accidents (n=23;74.19%), fall from height (n=7;22.58%) and firearm injuries (n=1;3.22%). The bone gaps ranged from 3-5 cm with a mean of 4.00± 0.856 cm. Bone union was achieved among 28(90.32%) patients. Infection was eradicated among 27(87.09%) patients whereas the remaining patients continued to suffer persistent infection. The most common complications included pin tract inflammation/ infection among (n=31;100%) patients and stiffness of knee joint among (n=19;61.29%) patients. Conclusion Majority of the patients were males, aged 9-16 years. Road traffic accidents were the commonest cause of the fractures. The Ilizarov method of segmental bone transport was effective in treating the majority of infected non-unions.
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Affiliation(s)
- Karim Bakhsh
- Dr. Karim Bakhsh, FCPS. Department of Orthopedics, Bolan Medical Complex Hospital, Quetta, Pakistan
| | - Faridullah Khan Zimri
- Dr. Faridullah Khan Zimri, FCPS. Department of Orthopedics, NIRM, Islamabad, Pakistan
| | - Eid Mohammad
- Dr. Eid Mohammad, FCPS. Department of Orthopedics, Bolan Medical Complex Hospital, Quetta, Pakistan
| | - Atiq-Ur-Rehman
- Dr. Atiq-Ur-Rehman, FCPS. Department of Orthopedics, Bolan Medical Complex Hospital, Quetta, Pakistan
| | - Muhammad Saaiq
- Dr. Muhammad Saaiq, FCPS. Department of Plastic Surgery, NIRM, Islamabad, Pakistan
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Oka Y, Kim WC, Yoshida T, Nakase M, Kotoura Y, Nishida A, Wada H, Shirai T, Takahashi K. Hybrid Fixation for Paediatric Femoral Supracondylar Fracture during Circular External Fixation of the Lower Limb. Strategies Trauma Limb Reconstr 2020; 15:179-183. [PMID: 34025800 PMCID: PMC8121111 DOI: 10.5005/jp-journals-10080-1454] [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] [Indexed: 01/22/2023] Open
Abstract
Aim To describe the novel hybrid fixation technique for paediatric femoral supracondylar fracture during circular external fixation of the lower limb. Background The Ilizarov external fixator is commonly used for various orthopaedic conditions. Difficulties associated with external fixation have previously been described. A fall while using a circular external fixator can cause ipsilateral fracture. Such fractures are ideally treated conservatively, but it is difficult to fix the frame itself. No study has reported the treatment of paediatric femoral supracondylar fracture during circular external fixation. Herein, we describe a novel hybrid fixation technique that was successfully used to treat paediatric femoral supracondylar fracture in three paediatric patients with circular external fixators. Technique The fracture was manually manipulated and reduced by slight hyperextension of the lower extremity under general anaesthesia. After confirmation of good reduction, a stockinette, a cast padding, and a thin core cast were applied to the ipsilateral thigh. The hinge parts were attached to the medial and lateral sides of the proximal ring. The rods were connected to the medial and lateral hinges, and the half ring was connected to the ventral side of the proximal end. Under fluoroscopic confirmation, the thin core cast of the thigh and rods were connected by cast rolled in a figure-of-eight manner. The hinges were locked with the knee joint slightly flexed. Conclusion The minimally invasive hybrid fixation technique enables conservative treatment of paediatric femoral supracondylar fracture during circular external fixation of the lower limb with no complications, and early exercise and recovery. Clinical significance This novel hybrid fixation technique will be an effective method for paediatric femoral supracondylar fracture in patients with a circular external fixator. How to cite this article Oka Y, Kim W-C, Yoshida T, et al. Hybrid Fixation for Paediatric Femoral Supracondylar Fracture during Circular External Fixation of the Lower Limb. Strategies Trauma Limb Reconstr 2020;15(3):179–183.
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Affiliation(s)
- Yoshinobu Oka
- Department of Pediatric Orthopaedics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Wook-Cheol Kim
- Department of Pediatric Orthopaedics and Ilizarov Center, Uji Takeda Hospital, Kyoto, Japan
| | - Takashi Yoshida
- Department of Orthopaedics, Kyoto Prefetural University of Medicine, Kyoto, Japan
| | - Masashi Nakase
- Department of Orthopaedics, Kyoto Prefetural University of Medicine, Kyoto, Japan
| | - Yoshihiro Kotoura
- Department of Orthopaedics, Kyoto Prefetural University of Medicine, Kyoto, Japan
| | - Atsushi Nishida
- Department of Orthopaedics, Kyoto Prefetural University of Medicine, Kyoto, Japan
| | - Hiroaki Wada
- Department of Orthopaedics, Kyoto Prefetural University of Medicine, Kyoto, Japan
| | - Toshiharu Shirai
- Department of Orthopaedics, Kyoto Prefetural University of Medicine, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Kyoto Prefetural University of Medicine, Kyoto, Japan
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Eccentric Taylor spatial frame placement for the correction of femoral fracture deformity: a novel technique. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:869-875. [PMID: 32124073 DOI: 10.1007/s00590-020-02639-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
The treatment of post-traumatic femoral deformity with circular frames can be difficult both for the patient and for the surgeon. Patients frequently suffer from residual knee stiffness, and the cumbersome location of the frame can even result in psychiatric problems such as depression and anxiety during their treatment. Here we describe a novel technique of constructing the Taylor spatial frame (TSF) eccentrically from the femur to allow the same level of comfort as a monolateral external fixator, while applying trigonometric principles to successfully retain the utility of the TSF prescription software. Deformity correction and fracture compression can therefore still be achieved in a controlled and predictable manner on an outpatient basis.
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Bor N, Rozen N, Dujovny E, Rubin G. Fixator-Assisted Plating in Pediatric Supracondylar Femur Fractures. Glob Pediatr Health 2019; 6:2333794X19843922. [PMID: 31041364 PMCID: PMC6484234 DOI: 10.1177/2333794x19843922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/07/2019] [Accepted: 03/05/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose. Pediatric femoral supracondylar fractures are difficult to reduce by either closed or open reduction. The abnormal muscle forces around the knee tend to significantly displace the distal short metaphyseal fragment. We describe a novel technique utilizing the combination of a temporarily intraoperative external fixation in order to achieve and maintain the reduction followed by internal fixation. Method. Three male patients younger than 16 years of age were operated in our department. The fractures were defined as pathological in 2 patients. In order to facilitate and maintain fracture reduction, an external fixator was temporarily used intraoperatively; once the fractures were internally fixed, the fixator was removed. Results. Anatomical reduction was achieved in all patients. In an average follow-up of 2 years, all the fractures are solidly healed and the various bone lesions are healing. All patients have returned to regular physical activity. Conclusion. Difficult supracondylar femur fractures in children are easier to manipulate and reduce with the assistance of an intraoperative external fixator. Once the fracture is internally fixed and stable, the external fixator is removed.
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Affiliation(s)
- Noam Bor
- Emek Medical Center, Afula, Israel.,Faculty of Medicine, Technion, Haifa, Israel
| | - Nimrod Rozen
- Emek Medical Center, Afula, Israel.,Faculty of Medicine, Technion, Haifa, Israel
| | | | - Guy Rubin
- Emek Medical Center, Afula, Israel.,Faculty of Medicine, Technion, Haifa, Israel
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Layton RB, Stewart TD, Harwood P, Messenger N. Biomechanical analysis of walking gait when simulating the use of an Ilizarov external fixator. Proc Inst Mech Eng H 2018; 232:628-636. [DOI: 10.1177/0954411918776694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Ilizarov frame is an external fixation device, primarily used for the treatment of complex fractures. The authors postulate that the size and weight of the frame may lead to biomechanical adaptations to gait, independent to any injury. Temporospatial characteristics, kinetics and kinematics were assessed when simulating the use of an Ilizarov frame. Fifteen healthy participants performed walking trials, with and without the simulated frame. Significant changes to temporospatial characteristics were identified, with a decreased mean walking speed (with: 1.24 m s–1; without: 1.29 m s–1) and increased mean step width (with: 0.14 m; without: 0.11 m). The push-off phase of gait differed significantly between test conditions with mean increases in ankle dorsiflexion angles (with: 90.4°; without: 89.0°) and extension moments (proportional to body weight or P BWT) at the knee and ankle (knee with: 0.8 P BWT·m; without: 0.7 P BWT·m; ankle with: 1.6 P BWT·m; without: 1.6 P BWT·m). Although changes were small and likely to be clinically insignificant, the size and weight of the frame led to adaptations which may be magnified for patient groups with associated injury and pain at the lower limb. Results provide an argument for the potential redesign of the frame.
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Affiliation(s)
- Robin B Layton
- School of Biomedical Sciences, University of Leeds, Leeds, UK
- Department of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Todd D Stewart
- Department of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Paul Harwood
- Leeds Major Trauma Centre, Leeds General Infirmary, Leeds, UK
| | - Neil Messenger
- School of Biomedical Sciences, University of Leeds, Leeds, UK
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Behera P, Gopinathan NR, Kumar A, Saibaba B, Sudesh P, John R. Distal femoral physeal crush injury with metaphyseal comminution - A report of two cases and a new perspective to physeal injury. Chin J Traumatol 2017; 20:366-369. [PMID: 29203221 PMCID: PMC5832456 DOI: 10.1016/j.cjtee.2017.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/10/2017] [Indexed: 02/04/2023] Open
Abstract
The physis of a long bone may get 'sandwiched' and crushed between the metaphysis and the epiphysis if it is traumatically loaded along its long axis. Such a physeal injury may lead to complications like angular deformities and growth restrictions and hence, management of such injuries requires adequate planning and attentive execution. Two patients with distal femoral physeal crush injury were treated using a ring fixator such that one ring had the wires passing through the epiphysis and the other through the femoral shaft. On table image intensifier controlled distraction of the crushed physis was done to bring the height of the physis similar to that of the opposite limb. Patients were followed up for more than two years clinically and radiologically. There was no clinical or radiological angular deformity of the operated limbs. MRI scans showed intact physes with no physeal bar formation in either of the two patients. The distraction obtained by the ring fixator appears to have provided ample 'breathing space' to the compressed physis and that the growth potential may have been re-gained by the procedure. However, two years is a relatively short duration of follow-up and further follow-up of longer duration and in greater number of patients is needed to gauge the actual effectiveness of the technique used by us.
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Affiliation(s)
- Prateek Behera
- Department of Orthopaedics, PGIMER, Chandigarh 160012, India,Central Institute of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi 110029, India,Corresponding author. Central Institute of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi, 110029, India.Assistant ProfessorCentral Institute of OrthopaedicsVMMC and Safdarjung HospitalNew Delhi110029India
| | | | - Avinash Kumar
- Department of Orthopaedics, PGIMER, Chandigarh 160012, India
| | - Balaji Saibaba
- Department of Orthopaedics, PGIMER, Chandigarh 160012, India
| | - Pebam Sudesh
- Department of Orthopaedics, PGIMER, Chandigarh 160012, India
| | - Rakesh John
- Department of Orthopaedics, PGIMER, Chandigarh 160012, India
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Percutaneous multiplanar subtrochanteric osteotomy with external fixation for developmental coxa vara (preliminary results). J Pediatr Orthop B 2017; 26:320-328. [PMID: 27748677 DOI: 10.1097/bpb.0000000000000392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
UNLABELLED Developmental coxa vara (DCV) develops during early childhood between the age of independent walking and 6 years. The deformity includes a decrease in the neck-shaft angle and femoral retroversion. Recently, good results have been reported using external fixator systems for the correction of proximal femoral deformities secondary to slipped capital femoral epiphysis, Perthes' disease in children, and percutaneous proximal femoral osteotomy for coxa vara. This preliminary study was performed to evaluate the results of percutaneous subtrochanteric osteotomy in restoring the normal alignment and orientation (radiographic outcome), thereby restoring the normal mechanics of the hip joint, overcoming shortening of the limb, and re-establishing the length-tension relationship of the abductor muscles (functional outcome). During the period between January 2009 and January 2012, a prospective study was conducted involving 30 (33 hips) patients with DCV and a preoperative Hilgenreiner's epiphyseal angle of 60° or greater on coronal radiographs. Clinical and radiological (anteroposterior radiograph of the pelvis) evaluation of patients was carried out preoperatively and postoperatively until union was achieved and fixator removal was carried out, and then at 6 months and at the final follow-up, with a minimum of 12 and a maximum of 33 months after surgery and an average of 20.8 months. We used the technique described by Sabharwal and colleagues (2005) to perform an acute, opened wedge subtrochanteric valgus-flexion-derotation femoral osteotomy using a percutaneous multiple drill hole technique. A low-profile Ilizarov external fixator was applied in each case. The average operative time (including anesthesia time) was 74 (range 60-130) min. The average time spent in the external fixator until union was 11 (range 7-15) weeks. The average intraoperative blood loss was 35 (range 10-150) ml, and no patient developed hemodynamic instability or required any postoperative blood transfusion. The hospital stay averaged 1.2 (range 1-2) days. Hilgenreiner's epiphyseal angle preoperatively averaged 70.6° (ranging from 55° to 90°). At 6 months it averaged 40.6° (ranging from 15° to 60°). At final follow-up it averaged 41.16° (ranging from 15° to 60°). Percutaneous subtrochanteric osteotomy with external fixation appears safe and effective in treating multiplanar proximal femoral deformities associated with DCV in children. LEVEL OF EVIDENCE Level IV.
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Abstract
BACKGROUND Treatment of a painful, chronically dislocated hip in nonambulatory children with cerebral palsy (CP) is challenging and controversial. Although many surgical options have been described, there is limited information, including patient-centered outcomes, following treatment. The purpose of our study was to evaluate the effect of a percutaneous subtrochanteric valgus osteotomy (SVO) using external fixation (EF) on hip abduction, radiographic parameters, and quality of life (QOL) measures in such patients. METHODS Fifteen nonambulatory patients (8 male, 7 female) with CP with 19 chronically dislocated hips underwent SVO using EF and adductor tenotomy at an average age of 14.3 years (range, 10.7 to 26.8 y). Changes in hip abduction and radiographic angular correction following surgery were assessed. Caregivers completed 2 surveys detailing differences in the patient's QOL measures, including severity and duration of pain and ease of nursing care, and the modified Child Health Index of Life with Disabilities (CPCHILD). RESULTS Caregivers of 11 patients completed both surveys at an average follow-up of 50 months (range, 17 to 119 mo) after fixator removal. There was improvement in pain, sitting tolerance, ease of transfers, and perineal care in the majority (9/11) of patients. The modified CPCHILD (possible score, 10 to 50) improved from 27.2 to 16.23 (P=0.05). Hip abduction improved from -7 degrees (range, -32 to 5 degrees) to 24 degrees (range, 0 to 40 degrees) (P<0.0001). The average valgus osteotomy correction was 48.2 degrees (range, 2.2 to 93.2 degrees). The pelvic femoral shaft angle improved from -15.2 degrees (range, -47.7 to 7.4 degrees) to 15.4 degrees (-44.3 to 44.6 degrees). There was some correlation of both, change in hip abduction (R=0.55) and osteotomy angle (R=0.60), with improvement in QOL measures. There were 3 major complications (20%) in 15 patients. CONCLUSIONS On the basis of preliminary results, percutaneous SVO stabilized with EF improves QOL in the majority of nonambulatory CP patients despite untoward events and is a viable alternative to open osteotomy with internal fixation. More robust comparative studies are needed to further assess the optimal salvage technique in this patient population. LEVEL OF EVIDENCE Level IV.
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Solomin LN, Andrianov MV, Takata M, Tsuchiya H. Reference positions for transosseous elements in femur: A cadaveric study. Injury 2016; 47:1196-201. [PMID: 27062129 DOI: 10.1016/j.injury.2016.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/22/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION During external fixator treatment, displacement of soft tissue at pin sites may cause infection and contracture. Due to surrounding soft tissue thickness, the femur is especially susceptible to severe complications. However, standard textbooks demonstrate only how major neurovascular bundles should be avoided. This study is the first cadaver study investigating which pin sites within safe zones exhibit minimal soft tissue displacement. METHODS To identify the clear direction of any pin, the femoral shaft was divided into eight levels, from I to VIII. The transverse sections at each level were further divided into 12 radial positions analogous to a clock face, where the anterior direction was assigned twelve o'clock, the medial three, etc. Fifteen adult cadavers were used. Twelve wires were aligned radially on the examined ring, and were dyed at each point toward the soft tissue. Each soft tissue displacement was measured by marking the surface before and after three particular joint motions, namely hip flexion (0-90°), abduction (0-45), and knee flexion (0-90). The same procedures were performed in three layers of soft tissue: skin, fascia, and muscle. RESULTS The average displacement was determined in 89 directions excluding the groin part, upon three joint motions. The three layers of skin, fascia, and muscle showed similar data curves. Greater displacements were seen at juxta-articular areas than at the mid-diaphyseal. The data curve exhibited a bimodal characteristic, with larger displacements at the extension and flexion directions. The amount of displacement at 6 o'clock was large at the levels near the hip joint, whereas at 12 o'clock, it was large near the knee joint. DISCUSSION "Reference positions" for transosseous elements were defined within zones absent neurovascular bundles, indicating 30 sites with minimal tissue displacement. Three or four directions at each level were chosen: I.9-11, II.9-11, III.8-11, IV.8-11, V.7-10, VI.3, 7-9, VII.3, 4, 8, 9, and VIII.3, 4, 8, 9. The anterolateral aspect near the hip joint and the posterolateral aspect near the knee tended to be chosen. They may prove useful in perioperative practice.
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Affiliation(s)
- Leonid N Solomin
- Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg, Russia
| | | | - Munetomo Takata
- Department of Orthopaedic Surgery, Kaga City Hospital, Kaga, Japan.
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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Abstract
Children with underlying metabolic bone diseases, such as osteogenesis imperfecta and spastic cerebral palsy, pose a challenge in the treatment of femoral shaft fractures. We performed flexible intramedullary nailing with supplemental monolateral external fixation in a subgroup of such patients. The external fixator assists in controlling angulation and rotation at the fracture site, and avoids the need for supplemental casting with its associated problems such as skin breakdown and difficulty with personal hygiene. We describe the surgical technique, pitfalls, and outcomes in a series of four patients with underlying osteopenia treated with external fixator-augmented flexible nailing for femoral shaft fractures.
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Abstract
BACKGROUND Recent advances in external fixation technique and pin design have sought to minimize complications such as pin site infection and premature removal of the external fixator. Although newer forms of internal fixation have gained popularity, external fixation may still have a role in managing pediatric femoral shaft fractures. QUESTIONS/PURPOSES We sought to assess the time to healing, limb alignment, and complications observed in a cohort of pediatric patients with closed femoral shaft fractures who were treated with external fixation. METHODS Over a 15-year period, one surgeon treated 289 pediatric patients with femur fractures, 31 (11%) of whom received an external fixator. The general indications for use of an external fixator during the period in question included length-unstable fractures, metadiaphyseal location, refracture, and pathologic fracture. Six patients (19%) had inadequate followup data and four patients (13%) were treated with a combination of flexible intramedullary nails and external fixation, leaving 21 patients for analysis. Mean age at injury was 10 years (range, 6-15 years) and followup averaged 22 months (range, 5-45 months) after removal of the fixator. Radiographs were examined for alignment and limb length discrepancy. Complications were recorded from a chart review. RESULTS Mean time in the fixator was 17 weeks (range, 9-24 weeks). One patient sustained a refracture and one patient with an isolated femur fracture had a leg length discrepancy > 2 cm. There were no pin site infections requiring intravenous antibiotics or additional surgery. One patient with Blount disease and previous tibial osteotomy developed transient peroneal nerve palsy. CONCLUSIONS Despite improvements in pin design and predictable fracture healing, complications such as refracture and leg length discrepancy after external fixation of pediatric femoral shaft fractures can occur. However, external fixation remains a viable alternative for certain fractures such as length-unstable fractures, metadiaphyseal location, pathologic fractures, and refractures. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Heather Kong
- Department of Orthopaedic Surgery, Rutgers University-New Jersey Medical School, Doctor's Office Center, 90 Bergen Street Suite 7300, Newark, NJ, 07103, USA,
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Parikh SN, Nathan ST, Priola MJ, Eismann EA. Elastic nailing for pediatric subtrochanteric and supracondylar femur fractures. Clin Orthop Relat Res 2014; 472:2735-44. [PMID: 23955195 PMCID: PMC4117889 DOI: 10.1007/s11999-013-3240-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Subtrochanteric and supracondylar femur fractures are difficult injuries to treat in children. Although elastic stable intramedullary nails are commonly used for pediatric femur shaft fractures, there is little information on their effectiveness for managing pediatric subtrochanteric and supracondylar femur fractures. QUESTIONS/PURPOSES We (1) evaluated radiographic union rates and fracture alignment after elastic nailing of pediatric subtrochanteric and supracondylar femur fractures, (2) identified complications, and (3) determined risk factors for complications. METHODS Between 2005 and 2011, 36 subtrochanteric fractures and eight supracondylar femur fractures were treated with elastic stable intramedullary nails and had complete followup until clinical and radiographic union. Elastic nailing was used for subtrochanteric fractures in children 5 to 12 years of age or after failed spica cast treatment in younger children and for displaced supracondylar fractures in children older than 5 years. Fracture alignment and union were measured on radiographs, and complications were identified from review of patient charts. Patients with and without complications were compared using nonparametric tests to identify risk factors. RESULTS All fractures healed; 23 of 33 (70%) subtrochanteric femur fractures and five of seven (71%) supracondylar femur fractures healed with anterior angulation of about 5°. For subtrochanteric fractures, complications included repositioning/removal of nails before radiographic union (n = 4), malunion (n = 2), fracture (n = 1), irritation (n = 1) at nail insertion site, and limb length discrepancy (n = 1); despite these complications, there were 22 (61%) excellent, 12 (33%) satisfactory, and only two (6%) poor outcomes. For supracondylar fractures, complications included infection after nail removal (n = 1) and nail site irritation (n = 2); there were three (38%) excellent, five (62%) satisfactory, and no poor outcomes. Complications were more likely after subtrochanteric fracture during motor vehicle accident (p = 0.045). CONCLUSIONS Although complication rates are high with elastic nailing for pediatric subtrochanteric (22%) and supracondylar (38%) femur fractures, elastic nailing represents an important option for difficult-to-manage femur fractures. LEVEL OF EVIDENCE Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Shital N Parikh
- Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2017, Cincinnati, OH, 45229, USA,
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Efficacy of a compliant semicircular Ilizarov pin fixator module for treating infected nonunion of the femoral diaphysis. Strategies Trauma Limb Reconstr 2014; 9:101-9. [PMID: 25070587 PMCID: PMC4122683 DOI: 10.1007/s11751-014-0199-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 07/22/2014] [Indexed: 10/27/2022] Open
Abstract
Percutaneous transosseous Ilizarov wiring, whilst preferred in the tibia because of its unique properties, carries a high risk of complications in the femur. The aim of this work was to evaluate the efficacy of a more patient-friendly semicircular pin external fixator module built up from parts of the Ilizarov fixator components and its use in managing diaphyseal femoral nonunions. A group of 20 patients with infected diaphyseal nonunions of the femur after internal osteosynthesis were included in this study. The mean age of the patients at the time of surgery was 46 years (range 16-60, SD 15.6). The mean morbidity time since the original trauma was 10.2 months (range 6-15, SD 2.5). All the cases were fixed by the described external fixator module. Bony union with resolution of infection occurred in 18 (94.7 %) out of 19 cases after a mean period in the fixator of 11.2 months (range 8-18 SD 2.9). After a mean follow-up period of 3.5 years (range 2-9, SD 2.6), there were 14 excellent, 3 good, 1 fair and 1 poor results from radiological evaluation and 10 excellent, 7 good, 1 fair and 1 poor results from functional assessment. In conclusion, the described semi-circular pin fixator module is patient-friendly and effective in managing infected nonunions of the femoral diaphysis.
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Lam HY, Lo CK, Cheung KY. The use of tibial Less Invasive Stabilization System (LISS) plate [AO-ASIF] for the treatment of paediatric supracondylar fracture of femur: a case report. J Orthop Surg Res 2010; 5:10. [PMID: 20167094 PMCID: PMC2831867 DOI: 10.1186/1749-799x-5-10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 02/18/2010] [Indexed: 11/17/2022] Open
Abstract
Paediatric supracondylar fractures of the femur are not common. The treatment options depend on the age of child, the site of the fracture, the pattern of injury and the surgeon's preference. We report a case of an 11-year old boy who sustained a comminuted displaced supracondylar fracture of the femur and was treated with indirect reduction and internal fixation with the Less Invasive Stabilization System (LISS) tibial plate.
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Affiliation(s)
- Hoi Yan Lam
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong.
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Antoci V, Raney EM, Antoci V, Voor MJ, Roberts CS. Transfixion wire positioning within the bone: an option to control proximal tibia external fixation stiffness. J Pediatr Orthop 2006; 26:466-70. [PMID: 16791063 DOI: 10.1097/01.bpo.0000226279.16449.8d] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The greatest angle that can be formed by the crossing wires at the proximal tibia level without altering safe corridors approaches only 60 degrees. Consequently, the wires are positioned more in the coronal than the sagittal plane. Looking for an increase in sagittal bending stiffness, we evaluated different wire positioning within the proximal tibia and their effect on the stiffness of external fixation of proximal tibia. STUDY DESIGN A fiberglass composite tibia fixed into an idealized ring external frame was tested with a servohydraulic test frame. Load-deformation behavior was compared among the different wire positioning within the proximal tibia under identical conditions of central axial compression, medial compression-bending, posterior compression-bending, posteromedial compression-bending, and torsion. Stiffness values were calculated from the load-deformation and the torque-angle curves. RESULTS The sample with 3 wires positioned within the bone-2 wires crossed 1 cm posteriorly from the center of the tibia and the third wire placed in coronal plane 1 cm anteriorly from the center of the tibia-was significantly (P < 0.05) stiffer in posterior, posteromedial, and torsional loading configurations compared with all other wire positions within the bone. CONCLUSIONS This new wire positioning within the proximal tibia-2 wires crossed 1 cm posteriorly from the center of the tibia and the third wire placed in coronal plane 1 cm anteriorly from the center of the tibia-increased overall stiffness of external fixation, predominantly in sagittal plane. CLINICAL RELEVANCE This work provides a rationale to control proximal tibia external fixation stiffness in sagittal plane.
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Sabharwal S, Mittal R, Zhao C. Percutaneous osteotomy for deformity correction in adolescents with severe slipped capital femoral epiphysis. J Pediatr Orthop B 2006; 15:396-403. [PMID: 17001244 DOI: 10.1097/01.bpb.0000228390.16937.f8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Various methods of performing proximal femoral realignment in adolescents with severe slipped capital femoral epiphysis exist. We report the technique and early results of a percutaneous, opening wedge subtrochanteric femoral osteotomy using an external fixator for correcting multiplanar deformities in such patients. Nine adolescents with severe slipped capital femoral epiphysis underwent a percutaneous osteotomy at an average age of 14.5 years. Mean operative blood loss was 61 ml, with 2 days of inpatient stay and 129 days of external fixation time. At an average follow-up of 23 months, hip flexion improved from 74 to 106 degrees, internal rotation from -5 to +17 degrees, external rotation from 71 to 41 degrees and abduction from 29 to 36 degrees. Radiographs revealed an improvement in anteroposterior head shaft angle from 112 to 134 degrees and lateral head shaft angle from 72 to 15 degrees. One patient had transient chondrolysis. No fixation-related problems, deep infection, avascular necrosis or refracture occurred. On the basis of our preliminary results, this percutaneous technique offers several advantages over currently available methods for surgical correction of severe slipped capital femoral epiphysis deformities.
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Affiliation(s)
- Sanjeev Sabharwal
- Department of Orthopedics, UMDNJ-New Jersey Medical School, Newark, New Jersey 07103, USA.
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