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Wang M, Su Y. Suitability of skin traction combined with braces for treating femoral shaft fractures in 3-5 years old children. J Orthop Surg Res 2023; 18:63. [PMID: 36683037 PMCID: PMC9869502 DOI: 10.1186/s13018-023-03547-5] [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: 10/24/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In children aged 3-5 years, femoral fractures are common and are frequently treated using flexible intramedullary nails (FIN) or spica casting. Recently, more surgeons have been relying on FIN surgery because of the high rate of complications associated with spica casts, such as skin irritation and re-adjustment surgery. We aimed to evaluate the effect of skin traction combined with braces in 3-5 years old children at our hospital. METHODS We retrospectively analyzed 125 children aged 3-5 years with femoral shaft fractures treated at our hospital between January 2010 and December 2020. We assigned 68 patients who underwent FIN surgery to Group A and 57 patients treated with skin traction and braces to Group B. Comparative analysis included the children's age, sex, side of the affected limb, cause of fracture, function of the knee joint, healing time of the fracture, duration of hospitalization, cost of hospitalization, and complications. The complications evaluated included joint dysfunction, pain, infection, pressure ulcers, angular deformities, limb length differences, re-fractures, nonunion fractures, and delayed union. RESULTS There were significant differences in and hospital costs (p = 0.001). Conversely, no statistically significant differences were observed in sex (p = 0.858), injury type (p = 0.804), age (p = 0.231), hospitalization time (p = 0.071), bone healing time (p = 0.212), and complications. Pressure ulcers, nonunion fractures, and delayed union did not occur in both groups. CONCLUSION Both methods had similar therapeutic effects and postoperative complications in children aged 3-5 years with femoral shaft fractures. Therefore, skin traction combined with braces is recommended for this population and for patients hospitalized in institutions where several beds are available, with a consequent possibility of prolonged hospitalization. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Menglei Wang
- grid.488412.3Department of Orthopedics, Chongqing Key Laboratory of Pediatrics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children’s Hospital of Chongqing Medical University, 136# Zhongshan 2 Road, Yuzhong District, Chongqing, 400014 China
| | - Yuxi Su
- grid.488412.3Department of Orthopedics, Chongqing Key Laboratory of Pediatrics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children’s Hospital of Chongqing Medical University, 136# Zhongshan 2 Road, Yuzhong District, Chongqing, 400014 China
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Tolk JJ, Merchant R, Eastwood DM, Buddhdev P, Hashemi-Nejad A. The Development of Leg Length Difference and Influence on Persistent Dysplasia in Patients with Developmental Dysplasia of the Hip. Indian J Orthop 2021; 55:1568-1575. [PMID: 35003543 PMCID: PMC8688656 DOI: 10.1007/s43465-021-00492-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/13/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Leg-length difference (LLD) is common in patients with developmental dysplasia of the hip (DDH). LLD of > 1 cm at skeletal maturity is reported in > 40% of patients, with the majority related to ipsilateral overgrowth. A longer DDH leg might lead to excessive mechanical loading at the acetabular margin, resulting in compromised acetabular development. We hypothesised that the LLD would negatively influence acetabular development. If so, it would be advantageous to identify such patients early in the course of follow-up, and address this if necessary. METHODS A retrospective study was conducted on a consecutive series of DDH patients managed surgically at the Royal National Orthopaedic Hospital, Stanmore, United Kingdom. We included patients with adequate long-leg radiographs at the age of 4-8 years (early-FU) and skeletal maturity (final-FU). Bilateral cases and those who underwent surgical procedures for hip dysplasia during the follow-up period were excluded. Measurements including leg length and centre-edge-angle (CE-angle) were obtained at the 2 time points. RESULTS Twenty-seven patients were included, mean age at early-FU 5.7 (± 0.9) years, and 13.9 (± 1.0) years at final-FU. Mean LLD at early-FU was 9.5 (± 7.6) mm and 10.9 (± 9.4) mm at final-FU, p = 0.337. Correlation between early- and final-FU LLD was 0.68 (p < 0.001). The mean CE-angle at early follow-up was 14.6° (± 9.8), this improved to 23.2° (± 8.2) at skeletal maturity (p = 0.003, paired samples t-test). Linear regression analysis showed a non-significant trend towards less CE-angle improvement in patients with more initial residual dysplasia and more initial LLD. CONCLUSION Most leg-length differences can be identified early in the follow-up period, nevertheless, considerable individual changes in LLD are observed on continued follow-up. Furthermore, a trend was observed towards impaired acetabular improvement in patients with more LLD. These findings justify careful clinical and radiological monitoring of LLD from an early stage in the follow-up period. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00492-5.
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Affiliation(s)
- Jaap J. Tolk
- Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, UK
- Department of Orthopaedic Surgery, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Rajiv Merchant
- Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Deborah M. Eastwood
- Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, UK
- Department of Orthopaedics, Great Ormond Street Hospital for Children, London, UK
| | - Pranai Buddhdev
- Department of Orthopaedic Surgery, Mid and South Essex NHS Trust, Chelmsford, Essex, UK
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van Cruchten S, Warmerdam EC, Kempink DRJ, de Ridder VA. Treatment of closed femoral shaft fractures in children aged 2-10 years: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2021; 48:3409-3427. [PMID: 34338819 PMCID: PMC9532337 DOI: 10.1007/s00068-021-01752-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/18/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To review current literature on treatment of closed femoral shaft fractures in children of 2-10 years old, with subgroup analysis of children aged 2-6 years, comparing intramedullary nailing (IMN) to conservative treatment modalities. METHODS We included clinical trials and observational studies that compared traction and subsequent casting (TSC), spica casting and IMN for treatment of femur shaft fractures in children of 2-10 years of age. Subgroup analysis of children aged 2-6 years was performed. RESULTS Compared to treatment with immediate spica casting, IMN led to significantly less coronal angulation (mean difference (MD): 2.03 degrees, confidence interval (CI) 1.15-2.90), less sagittal angulation (MD: 1.59 degrees, CI 0.82-2.35) and lower rates of LLD (Risk difference (RD): 0.07, CI 0.03-0.11). In terms of rehabilitation, IMN leaded to shorter time until walking with aids (MD: 31.53 days, CI 16.02-47.03), shorter time until independent ambulation (MD: 26.59 days, CI 22.07, 31.11) and shorter time until full weight bearing (MD: 27.05 days, CI 6.11, 47,99). Compared to TSC, IMN led to a lower rate of malunion (RD: 0.31, CI 0.05-0.56), shorter hospital stays (MD: 12.48 days, CI 11.57, 13.39), time until walking with aids (MD: 54.55, CI 40.05-69.04) and full weight bearing (MD: 27.05 days [6.11, 47,99]). CONCLUSION Although a lack of quality evidence, this systematic review showed a clear tendency to treatment with elastic intramedullary nails of femoral shaft fractures in children of 2-10 years of age. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Stijn van Cruchten
- UMC Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- , Kromme Nieuwegracht 15, 3512 HC, Utrecht, The Netherlands.
| | - Eefke C Warmerdam
- Reinier Haga Orthopedisch Centrum, Toneellaan 2, 2725 NA, Zoetermeer, The Netherlands
| | - Dagmar R J Kempink
- Erasmus MC/Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
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Kim TG, Park MS, Lee SH, Choi KJ, Im BE, Kim DY, Sung KH. Leg-length discrepancy and associated risk factors after paediatric femur shaft fracture: a multicentre study. J Child Orthop 2021; 15:215-222. [PMID: 34211597 PMCID: PMC8223087 DOI: 10.1302/1863-2548.15.200252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE This study was performed to investigate leg-length discrepancy (LLD) and associated risk factors after paediatric femur shaft fractures. METHODS A total of 72 consecutive patients under 13 years old (mean age 6.7 years; 48 boys, 24 girls) with unilateral femur shaft fracture, and a minimum follow-up of 18 months, were included. The amount of LLD was calculated by subtracting the length of the uninjured from that of the injured limb. Risk factors for an LLD ≥ 1 cm and ≥ 2 cm were analyzed using multivariable logistic regression analysis. RESULTS Hip spica casting, titanium elastic nailing and plating were performed on 22, 40 and ten patients, respectively. The mean LLD was 7.8 mm (sd 8.8) and 29 (40.3%) had a LLD of ≥ 1 cm, while nine (12.5%) had a LLD of ≥ 2 cm. There were significant differences in fracture stability (p = 0.005) and treatment methods (p = 0.011) between patients with LLD < 1 cm and ≥ 1 cm. There were significant differences in fracture site shortening (p < 0.001) and LLD (p < 0.001) between patients with length-stable and length-unstable fractures. Fracture stability was the only factor associated with LLD ≥ 1 cm (odds ratio of 4.0; p = 0.020) in the multivariable analysis. CONCLUSION This study demonstrated that fracture stability was significantly associated with LLD after paediatric femur shaft fractures. Therefore, the surgeon should consider the possibility of LLD after length-stable femur shaft fracture in children. LEVEL OF EVIDENCE Prognostic level III.
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Affiliation(s)
- Tae Gyun Kim
- Department of Orthopaedic Surgery, Konyang University Hospital, Daejeon, Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, Korea,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Hyeong Lee
- Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital, Gyeonggi, Korea
| | - Kug Jin Choi
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, Korea
| | - Byeong-eun Im
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, Korea
| | - Dae Yeung Kim
- Department of Orthopaedic Surgery, Konyang University Hospital, Daejeon, Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, Korea,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea,Correspondence should be sent to: Ki Kyuk Sung, Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi 13620, Korea. E-mail:
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Yaokreh JB, Sounkéré-Soro M, Tembely S, Kouamé YGS, Thomas AH, Odéhouri-Koudou TH, Kouamé BD, Ouattara O. Compared outcomes of femoral shaft fracture treatment in school-age children in Sub-Saharan Africa: Primary open reduction and intramedullary K-wire fixation versus traction followed by spica cast. Afr J Paediatr Surg 2021; 18:79-84. [PMID: 33642403 PMCID: PMC8232366 DOI: 10.4103/ajps.ajps_35_20] [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: 11/29/2022] Open
Abstract
BACKGROUND Elastic stable intramedullary nailing has become the treatment of choice for femur shaft fractures in school-age children in developed world. However, in the sub-Saharan Africa, this management is still challenging because of the lack of fluoroscopy in more hospitals. We performed either primary open reduction and intramedullary K-wire fixation (PORIKF) or conservative treatment. The aim of this study was to compare the clinical and functional outcomes of these two procedures employed. PATIENTS AND METHODS This retrospective study included 62 children with 64 fractures (10 years on an average; range: 6-15 years) treating for femoral shaft fractures either by PORIKF (n = 21; 23 fractures) or skin traction followed by spica cast (n = 41) between 2008 and 2017. Outcomes were assessed using Flynn criteria. Comparisons were made by Fisher and Student's t-test with a significant P < 5%. RESULTS Outcomes were satisfactory in 21 cases (91%) in the PORIKF group compared with 32 (78%) in the conservative group (P = 0.3012). The average hospital stay was 18.6 days in the PORIKF group, whereas it was 20 in the conservative group (P = 0.0601). The mean time for bone union was 13.9 weeks in the PORIKF group and 13.2 weeks in the conservative group, (P = 0.4346). There was a statistically significant difference between the two groups in terms of major complications (P = 0.0177). One patient had osteomyelitis in the PORIKF group. Unacceptable shortening >2 cm was observed only in the conservative group. The average time to return to daily activities was 30 days shorter in the PORIKF group when compared to conservative group (P < 0.05). CONCLUSION PORIKF provides better results than conservative treatment. Open reduction did not increase the rate of infectious complication.
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Affiliation(s)
| | | | - Samba Tembely
- Department of Pediatric Surgery, CHU Yopougon, Abidjan 21, Côte d'Ivoire
| | | | | | - Thierry-Hervé Odéhouri-Koudou
- Department of Pediatric Surgery; Emergency Department of Medicine and Surgery, CHU Yopougon. 21 P.O.Box 632 Abidjan 21, Côte d'Ivoire
| | - Bertin Dibi Kouamé
- Department of Pediatric Surgery, CHU Yopougon, Abidjan 21, Côte d'Ivoire
| | - Ossénou Ouattara
- Department of Pediatric Surgery, CHU Yopougon, Abidjan 21, Côte d'Ivoire
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Debuka E, Kushwaha NS, Kumar D, Singh A, Sharma V. Rust score-An adequate rehabilitation guide for diaphyseal femur fractures managed by TENS. J Clin Orthop Trauma 2019; 10:922-927. [PMID: 31528069 PMCID: PMC6738353 DOI: 10.1016/j.jcot.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/18/2018] [Accepted: 06/26/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The optimal mode of treatment among the wide variety of surgical and nonsurgical treatment options for children between 5 and 15 years of age continues to be controversial. Elastic stable intramedullary nailing of long bone fractures in the skeletally immature has gained widespread popularity because of its clinical effectiveness and low risk of complications. METHODS AND METHODOLOGY From Jan 2015 to August 2016, 35 patients including 37 limbs with diaphyseal fractures of the femur in the age group 5-15 years were managed by Titanium Elastic nailing and their clinico-radiological and functional outcome was assessed at 1 year post operatively as per the Flynn's criteria. RUST score was used as a guide for post-operative rehabilitation. RESULTS 37 patients were managed by TENS nailing including 28 males and 9 females. The outcome in proximal, middle or distal fractures of the shaft were found to be similar and the difference was statistically insignificant. Similarly, the difference in the outcomes as per fracture patterns was also found to be statistically insignificant. Partial weight bearing was allowed after a score of 6 was achieved and full weight bearing after a score of 8. CONCLUSION As per the Flynn's criteria, 75% of the patients (28 out of 37) were found to have an excellent outcome while 7 had a satisfactory outcome and two had a poor outcome. RUST score can be used as an effective guide for post op rehabilitation.
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Abstract
PURPOSE To evaluate the efficacy of intramedullary Kirschner wires for the treatment of unstable tibial shaft fractures in children. METHODS This prospective study was conducted at the Department of Orthopaedic Surgery in Maharishi Markandeshwar Medical College from June 2005 to June 2010. Sixty-six children having closed fracture of the tibial shaft with a mean age of 7.7 years (range, 2-14 years) were recruited from emergency and outpatient department. They were treated with percutaneous intramedullary Kirschner wires. The clinical results of our study were rated on the basis of the criteria of union, nonunion, delayed union or malunion. All children were followed for one year. RESULTS Children achieved union in a mean time of 8 weeks (range, 6-10 weeks). Postoperatively, three children (4.55%) had delayed union, one (1.52%) valgus deformity of lower leg, three (4.55%) post- operative knee pain and twelve (18.18%) skin irritation at pin site.Wires were removed after 8-22 weeks without any complications. No patient was lost to follow-up. The results were excellent in 95.45% and good in 4.55% children. CONCLUSION This technique is cost-effective, simple, quick to perform, safe and reliable and avoids pro- longed hospitalization with good results.
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Guo YC, Feng GM, Xing GW, Yin JN, Xia B, Dong YZ, Niu XQ, He Q, Hu P. A meta-analysis of flexible intramedullary nailing versus external fixation for pediatric femoral shaft fractures. J Pediatr Orthop B 2016; 25:466-70. [PMID: 27294706 DOI: 10.1097/bpb.0000000000000336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To compare the difference in efficacy following flexible intramedullary nailing (FIN) and external fixation (EF) for pediatric femoral shaft fractures. A systematic search was performed on PubMed, Embase, Medline, and Cochrane library for relevant studies. We included controlled trials comparing complications between FIN and EF for pediatric femoral shaft fractures published before 25 November 2014. Modified Jadad scores were utilized to assess the methodological quality of the studies included. The meta-analysis was carried out using Stata 12.0 software. Six studies involving 237 patients were included. On comparison of EF, a low incidence of overall complications [relative risk (RR)=0.30, 95% confidence interval (CI): 0.19-0.46; P<0.001] and pin-tract infection (RR=0.286, 95% CI: 0.13-0.61; P=0.001), but a high risk of soft tissue irritation (RR=1.86, 95% CI: 1.35-2.56; P<0.001) were found in patients treated with the FIN approach. No significant differences in other complications were found. On the basis of current evidence, the use of FIN leads to fewer complications than EF and may be considered as the first-line approach in the treatment of femoral shaft fractures.
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Affiliation(s)
- Yong Cheng Guo
- aDepartment of Orthopedics, the Third Affiliated Hospital of Zhengzhou University bDepartment of Internal Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou,China
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