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Greenhill DA, Riccio AI, Herman MJ. Treatment of Length-Unstable Pediatric Femur Fractures in Children Aged 5 to 11 years: A Focused Review. J Am Acad Orthop Surg 2024; 32:373-380. [PMID: 38639649 DOI: 10.5435/jaaos-d-23-00995] [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] [Received: 10/28/2023] [Accepted: 02/25/2024] [Indexed: 04/20/2024] Open
Abstract
Pediatric femur fractures in children aged 5 to 11 years are typically classified as length-stable versus length-unstable. For length-stable fracture patterns, there is frequent consensus among pediatric orthopaedic specialists regarding the appropriateness of flexible intramedullary nails, submuscular plates (SMP), or lateral-entry rigid intramedullary nails (LE-RIMN). With length-unstable fracture patterns, however, the decision is more complex. Age, weight, fracture pattern, fracture location, surgical technique, surgeon experience, several implant-specific details, and additional factors are all important when choosing between flexible intramedullary nail, SMP, and LE-RIMN. These familiar methods of fixation may all be supported by conflicting and sometimes heterogeneous data. When planning to treat length-unstable fractures in young children, surgeons should understand evidence-based details associated with each implant and how each patient-specific scenario affects perioperative decisions.
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Affiliation(s)
- Dustin A Greenhill
- From the St. Luke's Children's Hospital at St. Luke's University Health Network, Bethlehem, PA (Greenhill), the Lewis Katz School of Medicine at Temple University, Philadelphia, PA (Greenhill), the Scottish Rite Hospital for Children, Dallas, TX (Riccio), the Department of Orthopedic Surgery, University of Texas Southwestern, Dallas, TX (Riccio), the St. Christopher's Hospital for Children, Philadelphia, PA (Herman); and the Drexel University College of Medicine, Philadelphia, PA (Herman)
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Liu W, Li W, Bai R, Xu X, Zhao Z, Wang Y. Elastic Stable Intramedullary Nailing Versus Plate Internal Fixation for Pediatric Diaphyseal Femur Fractures: A Systematic Review and Meta-analysis. Indian J Orthop 2024; 58:484-494. [PMID: 38694693 PMCID: PMC11058146 DOI: 10.1007/s43465-024-01125-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/11/2024] [Indexed: 05/04/2024]
Abstract
Background Elastic stable intramedullary nailing (ESIN) and plates are currently the main internal fixation for treating Pediatric Diaphyseal Femur Fractures (PDFF), and the optimal choice of internal fixation is controversial. The purpose of this meta-analysis is to compare the surgical outcomes and complications of the two fixation methods. Materials and Methods MEDLINE, Embase, and the Cochrane Library were systematically searched for studies published up to March, 2023, that compared ESIN and plate fixation techniques for treating PDFF. Pooled analysis identified differences in surgical outcomes between ESIN and plate, mainly regarding surgical outcomes and postoperative complications, such as time at surgery, fracture healing time, blood loss and related complications. Results We included 10 studies with 775 patients with PDFF in our review. Of these, 428 and 347 were treated with ESIN and Plate, respectively. In terms of postoperative complications, ESIN led to a shorter surgery time [MD = - 28.93, 95% CI (- 52.88 to - 4.98), P < 0.05], less blood loss [MD = - 66.94, 95% CI (- 87.79 to - 46.10), P < 0.001] and more fracture healing time [MD = 2.65, 95% CI (1.22-4.07), P < 0.001]. In terms of postoperative complications, ESIN led to fewer fections (RR = 0.77, 95% CI 0.37, 1.60, P = 0.48), fewer angulation deformities (RR = 0.80, 95% CI 0.35, 1.83, P = 0.60) and more prominent implants (RR = 3.36, 95% CI 1.88, 6.01, P < 0.001), more delayed unions (RR = 4.06, 95% CI 0.71, 23.06, P = 0.11). Conclusions ESIN and Plate have similar rates of complications besides a prominent implant rate, while ESIN has a shorter period of operation and less intraoperative bleeding. Although both options are suitable, the results of this study support the use of ESIN rather than plates in the treatment of PDFF in terms of complication rates. In clinical applications, surgeons should choose the appropriate treatment method according to the actual situation.
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Affiliation(s)
- Wanlin Liu
- Department of Orthopaedic, The Second Affiliated Hospital of Inner Mongolia, Medical University, Hohhot, 010030 Inner Mongolia China
| | - Wenqiang Li
- Department of Inner Mongolia Medical University, Hohot, 010030 Inner Mongolia China
| | - Rui Bai
- Department of Orthopaedic, The Second Affiliated Hospital of Inner Mongolia, Medical University, Hohhot, 010030 Inner Mongolia China
| | - Xiangyu Xu
- Department of Inner Mongolia Medical University, Hohot, 010030 Inner Mongolia China
| | - Zhenqun Zhao
- Department of Orthopaedic, The Second Affiliated Hospital of Inner Mongolia, Medical University, Hohhot, 010030 Inner Mongolia China
| | - Yan Wang
- Department of Orthopaedic, The Second Affiliated Hospital of Inner Mongolia, Medical University, Hohhot, 010030 Inner Mongolia China
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Neto MA, Paulino MF, Amaro AM. Effect of Plate Configuration in the Primary Stability of Osteotomies and Biological Reconstructions of Femoral Defects: Finite-Element Study. Bioengineering (Basel) 2024; 11:416. [PMID: 38790284 PMCID: PMC11117963 DOI: 10.3390/bioengineering11050416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND/OBJECTIVE Osteosynthesis is an alternative treatment for stabilizing femur-bone traumas. The initial stability of the fixation systems is one of the biomechanical parameters affecting implant failure and bone union, especially in surgeries of intercalary reconstructions after the removal of bone tumors. This study aimed to investigate the initial biomechanical effect of using one or two osteosynthesis plate configurations for femoral fixation and the effect of fastening the allograft to the osteosynthesis plate in the case of femoral allograft reconstructions. METHODS Three finite-element models of a femur with three different fixation conditions for a transverse osteotomy in the middle of the diaphysis, i.e., using one and two osteosynthesis plates and an intercalary allograft, were constructed. An eight-hole compression plate and a six-hole second plate were used to simulate osteosynthesis plates. The plate screws were tightened previously to the loading, and the tightening sequences simulate the bolt-tightening procedure in a surgical environment. The models were imported into the ADINA System for nonlinear analysis, using compression loads applied over the femur head. RESULTS Models with the dual fixation systems had the most outstanding compression stiffness. The femur head movement in the dual plate system was 24.8% smaller than in the single plate system. A statistical analysis of a region of interest (VOI) placed in the femur diaphysis showed that the biomechanical effect of using the dual plate system is smaller in the osteotomy region than at the femur head, e.g., a displacement average decrease of only 5% between the two systems, while the maximum value decreases by 26.8%. The allograft fixation to the second osteosynthesis plate leads to an improvement in the system stability. CONCLUSIONS The results presented in this work show that including the bolt analysis in the femoral diaphysis osteotomy fixation will allow for capturing the nonlinear behavior of the osteotomy region more realistically. The stability of the intercalary reconstruction of the femoral diaphysis was higher when the allograft was fastened to the second osteosynthesis plate.
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Affiliation(s)
- M. A. Neto
- University of Coimbra, CEMMPRE, ARISE, Department of Mechanical Engineering, 3030-788 Coimbra, Portugal; (M.F.P.); (A.M.A.)
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Garg V, Gowda AKS, Regmi A, Barik S, Maheshwari VK, Singh V. Management of Length Unstable Femur Fractures in Children by Flexible Intramedullary Nails: A Systematic Review. ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE CECHOSLOVACA 2024; 91:44-51. [PMID: 38447564 DOI: 10.55095/achot2024/006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
PURPOSE OF THE STUDY Surgical options for paediatric femoral fractures include fl exible intramedullary nailing (FIN), plating, and external fi xators. Length unstable fractures are usually spiral, long oblique, or comminuted and are often associated with > 2 cm of shortening. The purpose of this study was to see whether FIN is effective for managing unstable femur fractures in children. MATERIAL AND METHODS An electronic literature search was performed up to 25 February 2022 in Cochrane Library, PubMed, and Embase databases using a combination of MeSH search terms and keywords related to the population (e.g., "child" AND "diaphyses" AND "femur"), and intervention (e.g., "nail" OR "ESIN"). The data extracted included the study details, Demographic data, surgical details, postoperative immobilization, complications, and outcome. RESULTS Eight studies with a total sample size of 369 patients were reviewed. The mean operative time, blood loss, and length of stay in the hospital were 67.62±12.32 minutes, 33.82±16.82 ml, and 4.9±1.27 days, respectively. The results were excellent in 61.92% of the patients, satisfactory in 32.61%, and poor in 5.43%. 4.54% of patients had major complications requiring reoperation and 32.46% of patients had minor complications. the most common complication was nail prominence seen in 26.30% of patients. Locked Ender's nail was associated with the least reoperation, malunion, and LLD rate compared to other types of FIN. CONCLUSIONS FIN along with a single walking spica cast is a good choice in all forms of paediatric femoral fracture patterns allowing proper alignment and rotation. Locked Ender's nail is safe and effective for managing unstable paediatric femur fracture. KEY WORDS pediatric femur fracture, length unstable, fl exible intramedullary nailing, submuscular plating, Flynn criterion.
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Affiliation(s)
- V Garg
- Department of Orthopedics, Chacha Nehru Bal chikitsalaya, Geeta colony, Delhi, India
| | - A K S Gowda
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - A Regmi
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - S Barik
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - V K Maheshwari
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - V Singh
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Li D, Wang X, Lu J, Xue M. Submuscular plating vs. elastic stable intramedullary nailing for diaphyseal femur fractures in children: a systematic review and meta-analysis. Front Pediatr 2023; 11:1256630. [PMID: 38027269 PMCID: PMC10663353 DOI: 10.3389/fped.2023.1256630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives This review evaluates the safety and efficacy of submuscular plating (SMP) vs. elastic stable intramedullary nailing (ESIN) in the treatment of pediatric femur shaft fracture. Method Studies comparing the efficacy and safety of SMP and ESIN in pediatric shaft fracture were retrieved from five databases (PubMed, Embase, Cochrane, OVID, and Web of Science) from inception to March 2023 using a systematic literature search strategy. A total of 13 outcome measures, such as perioperative parameters, clinical outcomes, and radiographic results, were included in the meta-analysis. Results Eight eligible studies involving 491 patients were included in the narrative synthesis. There were no significant differences in baseline characteristics between the two groups. Meta-analysis showed reduced radiation time (RT), soft tissue irritation and angular deformation in the SMP group than in the ESIN group. However, the SMP group had greater estimated blood loss (EBL) than the ESIN group. The duration of surgery, length of hospital stay (LOS), implant removal, complications requiring surgery, Flynn score, incidence of infection, fracture healing time, and limb length discrepancy (LLD) were similar between the two groups. Only one study reported higher incidences of fracture nonunion or delayed healing in the ESIN group. Conclusion SMP is an effective and safe intervention superior to ESIN in reducing soft tissue irritation, angular deformation and radiation time. Given the presence of potential bias and heterogeneity, surgeons should select the treatment that would provide the best outcomes for EBL, LOS, operation time, and bone nonunion or delayed healing based on their experience. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023404118, Identifier PROSPERO (CRD42021228512).
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Affiliation(s)
- Donghui Li
- Department of Pediatric Orthopedic, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Xiangyue Wang
- Department of Radiation, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jialing Lu
- Department of Pediatric Orthopedic, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Mingfeng Xue
- Department of Pediatric Orthopedic, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
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Hu D, Xu Z, Shi T, Zhong H, Xie Y, Chen J. Elastic stable intramedullary nail fixation versus submuscular plate fixation of pediatric femur shaft fractures in school age patients: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e35287. [PMID: 37773849 PMCID: PMC10545301 DOI: 10.1097/md.0000000000035287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/29/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Studies of clinical outcomes that compare the elastic stable intramedullary nail (ESIN) with the submuscular plate (SMP) were controversial. The meta-analysis was performed to summarize existing evidence, aiming to determine whether ESIN was superior to SMP in pediatric femur shaft fractures. METHODS Search strategies followed the recommendations of the Cochrane collaboration. Electronic searches such as PubMed, Embase, Web of Science, Cochrane were systematically searched for publications concerning ESIN and SMP from the inception date to March 2023. Two investigators independently searched, screened, and reviewed the full text of the article. Disagreements generated throughout the process were resolved by consensus, and if divergences remain, they were arbitrated by a third author. RESULTS This study included 8 articles, comprising a total of 561 patients with a similar baseline. Compared to the SMP, the ESIN had shorter operation time (mean difference = -16.16; 95% CI = -22.83 to -9.48, P < .00001), and less intraoperative blood loss (mean difference = -53.62; 95% CI = -58.89 to -48.36, P < .00001), but had a higher incidence of implant irritation (odds ratio [OR] = 6.49; 95% CI = 3.01 to 13.98, P < .0001), lower limb malalignment (OR = 2.60; 95% CI = 1.12 to 6.04, P = .96) and overall complications(OR = 4.14; 95% CI = 2.51 to 6.84, P < .0001). And there was no significant difference in radiation time, length of hospital stay, limb length discrepancy, infection rate, delayed union rate and unplanned revised surgery rate (P > .05). CONCLUSIONS Compared to the SMP, the ESIN offers shorter operative time, and less blood loss. However, the SMP is superior to ESINs in complication rates, especially regarding implant irritation and malalignment. Both methods could achieve excellent satisfactory functional outcomes. Thus, the SMP is an alternative choice in the pediatric femur shaft fracture.
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Affiliation(s)
- Donglai Hu
- Department of Pediatric Surgery, Jinhua Central Hospital, Jinhua, China
| | - Zihang Xu
- Department of Pediatric Orthopedic Surgery, Jinhua Maternity and Child Health Care Hospital, Jinhua, China
| | - Tao Shi
- Department of Pediatric Orthopedic Surgery, Jinhua Maternity and Child Health Care Hospital, Jinhua, China
| | - Hui Zhong
- Department of Pediatric Orthopedic Surgery, Jinhua Maternity and Child Health Care Hospital, Jinhua, China
| | - Yuting Xie
- Department of Pediatric Orthopedic Surgery, Jinhua Maternity and Child Health Care Hospital, Jinhua, China
| | - Junjie Chen
- Department of Pediatric Surgery, Jinhua Central Hospital, Jinhua, China
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Strait RT, Pankey C. Submuscular Plating Versus Elastic Intramedullary Nailing in Children with Femoral Shaft Fracture; a systematic review and meta-analysis. J Clin Orthop Trauma 2023; 42:102203. [PMID: 37529550 PMCID: PMC10388584 DOI: 10.1016/j.jcot.2023.102203] [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: 12/22/2022] [Revised: 04/27/2023] [Accepted: 06/24/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction Elastic stable intramedullary nailing (ESIN) is currently the technique of choice for pediatric femoral fractures. Submuscular plating (SMP) allows reliable healing associated with an early range of motion. The following systematic review and meta-analysis was carried out to reveal the functional and surgical outcomes of SMP and ESIN for fixation of pediatric femoral fractures and to aid in the decision-making processes for those who perform these procedures. Methods An extensive systematic literature review was implemented from inception to 23 February 2022. All clinical studies included had patients that were younger than 18 years old with femoral shaft fractures that compared outcomes between SMP and ESIN. Studies including patients with pathological fractures, closed femoral physis, multiple fractures, or refractures were excluded. Results This meta-analysis included six articles encompassing 568 patients. Of them, 206 patients were treated with SMP, while 362 were subjected to ESIN procedure. There was significantly more blood loss among patients treated with SMP (MD -45.45; 95% -61.62, -29.27; p < 0.001). The risk of postoperative adverse surgical events was significantly higher among patients subjected to the ESIN (RR 2.97 19.5; 95% 1.27, 6.98; p = 0.01). The mean hospital stay was significantly shorter among patients subjected to ESIN (SMD -1.47; 95% -2.43, -0.51; p = 0.003). Patients subjected to SMP showed significantly more EFOs when comparing Flynn Scores (OR 0.24; 95% 0.09, 0.64; p = 0.004). There was no significant difference between SMP and ESIN regarding the mean operation time, limb length discrepancy, and mean time to union. Conclusions Children with femoral shaft fractures can be managed effectively and safely with SMP. There was a similar surgical outcome between SMP and ESIN, but SMP had more EFOs. While SMP was associated with a low risk of postoperative adverse surgical events, it was associated with a more significant blood loss and prolonged hospital stays.
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Affiliation(s)
- Robert Taylor Strait
- West Virginia School of Osteopathic Medicine, 400 Lee Street North, Lewisburg, 24901, West Virginia, United States
| | - Christopher Pankey
- West Virginia School of Osteopathic Medicine, 400 Lee Street North, Lewisburg, 24901, West Virginia, United States
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Edwards TA, Daly C, Donovan RL, Whitehouse MR. Risk of complications following surgical fixation of femoral diaphyseal fractures in children aged 4 to 12 years: A systematic review and meta-analysis. Injury 2022; 53:1020-1028. [PMID: 34782115 DOI: 10.1016/j.injury.2021.11.005] [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: 05/07/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is debate regarding the optimal surgical technique for fixing femoral diaphyseal fractures in children aged 4 to 12 years. The National Institute for Health and Care Excellence (NICE) and the American Academy of Orthopaedic Surgeons (AAOS) have issued relevant guidelines, however, there is limited evidence to support these. The aim of this study was to conduct a systematic review and meta-analysis to compare the complication rate following flexible intramedullary nailing (FIN), plate fixation and external fixation (EF) for traumatic femoral diaphyseal fractures in children aged 4 to 12. METHODS We searched MEDLINE, EMBASE and CENTRAL databases for interventional and observational studies. Two independent reviewers screened, assessed quality and extracted data from the identified studies. The primary outcome was the risk of any complication. Secondary outcomes assessed the risk of pre-specified individual complications. RESULTS Nine randomised controlled trials (RCTs) and 19 observational studies fulfilled the eligibility criteria. Within the RCTs, five analysed FIN (n = 161), two analysed plates (n = 51) and five analysed EF (n = 168). Within the observational studies, 13 analysed FIN (n = 610), seven analysed plates (n = 214) and six analysed EF (n = 153). The overall risk of complications was lower following plate fixation when compared to FIN fixation (RR 0.45, 95% CI 0.28 to 0.73, p = 0.001) in the observational studies. The overall risk of complications was higher following EF when compared to FIN fixation in both RCTs (RR 1.94, 95% CI 1.25 to 3.01, p = 0.003) and observational studies (RR 1.97, 95% CI 1.50 to 2.58, p<0.001). The overall risk of complications was higher following EF when compared to plate fixation in both RCTs (RR 7.42, 95% CI 1.84 to 29.98, p = 0.005) and observational studies (RR 4.39, 95% CI 2.64 to 7.30, p<0.001). CONCLUSION Although NICE and the AAOS recommend FIN for femoral diaphyseal fractures in children aged 4 to 12, this study reports a significantly decreased relative risk of complications when these injuries are managed with plates. The overall quality of evidence is low, highlighting the need for a rigorous prospective multicentre randomised trial at low risk of bias due to randomisation and outcome measurement to identify if any fixation technique is superior.
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Affiliation(s)
- Tomos A Edwards
- Trauma and Orthopaedic Department, North Bristol NHS Trust, Brunel Building, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom.
| | - Catriona Daly
- Trauma and Orthopaedic Department, Somerset NHS Foundation Trust, Musgrove Park Hospital, Parkfield Drive, Taunton, TA1 5DA, United Kingdom
| | - Richard L Donovan
- Trauma and Orthopaedic Department, North Bristol NHS Trust, Brunel Building, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Michael R Whitehouse
- Trauma and Orthopaedic Department, North Bristol NHS Trust, Brunel Building, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, United Kingdom; National Institute for Health Research, Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol
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Hong P, Zhao X, Ze R, Rai S, Liu R, Li J, Tang X. Operative choice for subtrochanteric femoral fracture in school-aged children: Triple elastic stable intramedullary nail versus locking plate. Front Pediatr 2022; 10:894262. [PMID: 35958179 PMCID: PMC9360405 DOI: 10.3389/fped.2022.894262] [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: 03/11/2022] [Accepted: 07/01/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The management strategy of subtrochanteric fractures remains controversial, and triple elastic stable intramedullary nail (ESIN) has not been reported for pediatric subtrochanteric fractures. This study aimed to compare the clinical effects of treating school-aged children with subtrochanteric fractures with triple ESINs versus locking plates. METHODS We conducted a retrospective review of pediatric patients with subtrochanteric femoral fracture receiving either triple ESINs (TE) or locking plates (LPs) between January 2010 and January 2018. Sixteen patients in each group with matched age, sex, and fracture characteristics were included in the study. The preoperative data, including baseline information of the patients, fracture pattern, and types of surgical procedure, were collected from the hospital database. Patients were followed-up at the outpatient clinic in the 3rd month, 6th month, 12th month, and annually afterward. Hardware removal was performed at 9 - 18 months after the primary surgery. RESULTS In all, 16 patients (8.4 ± 1.5-year-old, 7 boys, 9 girls) in the TE group and 16 patients (8.4 ± 1.4-year-old, 7 boys, 9 girls) in the LP group were included. There was significantly less operative time, reduced estimated blood loss, and shortened hospital stay for the TE as compared with the LP (P < 0.001). However, higher fluoroscopy frequency was observed in the TE group than in the LP group (P < 0.001). The time to union was faster in the TE group than in the LP group (P = 0.031). However, the angulation was higher in the TE group (3.2 ± 0.6) than the LP group (1.8 ± 0.5), and the incidence of implant prominence was higher in the TE group (7/16, 43.8%) than the LP group (1/16, 6.3%). CONCLUSION Compared with the locking plates, triple ESINs demonstrated significantly less operative time, reduced estimated blood loss, and shortened hospital stay. Besides, both TE and LP groups produced satisfactory outcomes in school-aged children with subtrochanteric fractures. Therefore, TE remains a feasible choice for subtrochanteric fractures in school-aged children.
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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
| | - Xiaolong Zhao
- Department of Orthopaedics, First Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Renhao Ze
- 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, Blue Cross Hospital, Tripureswor, Kathmandu, Nepal.,Department of Orthopaedics and Trauma Surgery, Karama Medical Center, Dubai Investment Park Br, Dubai, United Arab Emirates
| | - Ruikang Liu
- Department of Endocrinology, Union Hospital, 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
| | - Xin Tang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Hong P, Rai S, Tang X, Liu R, Li J. Operative Choice for Length-Unstable Femoral Shaft Fracture in School-Aged Children: Locking Plate vs. Monolateral External Fixator. Front Pediatr 2021; 9:799487. [PMID: 35223711 PMCID: PMC8866316 DOI: 10.3389/fped.2021.799487] [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: 10/21/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Locking plate (LP) is a good choice in the treatment of length-unstable femoral shaft fracture in children. Monolateral external fixator (EF) has been reported for this condition for decades. This study aims to compare the clinical outcomes of school-aged children with length-unstable femoral shaft fracture treated with LP vs. EF. METHODS Patients aged 5-11 years old with length-unstable femoral shaft fractures treated at our institute from January 2014 to January 2018 were retrospectively reviewed and categorized into LP and EF groups. The preoperative data, including baseline information of the patients, radiographic parameters, and types of surgical procedure, were collected from the hospital database, and postoperative data, including complications, were collected during the follow-up visits. RESULTS Overall, 36 patients (average, 8.2 ± 2.1 years; male, 20; female, 16) in the LP group and 35 patients (average, 8.3 ± 2.3 years; male 20, female 15) in the EF group were included. There was significantly less operative time for EF (45.4 ± 7.8 min) compared with LP (67.8 ± 11.3 min) (P < 0.001). As for the frequency of fluoroscopy, there was a significant difference between the EF (13.9 ± 2.4) and LP (16.5 ± 3.2) groups (p < 0.001). The rate of major complications was not significantly different between these two groups. There was a significant difference between the EF group (11.2 ± 5.8 mm) and the LP group (7.5 ± 1.6 mm) group concerning limb length discrepancy (P < 0.001). CONCLUSION Both LP and EF produce satisfactory outcomes in school-aged children with length unstable femoral shaft fractures. External fixation remains a viable choice without the necessity of secondary surgery for hardware removal.
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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, Blue Cross Hospital, Kathmandu, Nepal
| | - 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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