AAOS Clinical Practice Guideline on the Treatment of Pediatric Diaphyseal Femur Fractures

Jevsevar, David S.; Shea, Kevin G.; Murray, Jayson; Sevarino, Kaitlyn

doi:10.5435/jaaos-d-15-00523

Cited by 62 publications

(69 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The guidelines recommend spica casting in patients aged 6 months to 5 years and flexible intramedullary nailing for patients aged 5 to 11 years, with the level of evidence ranging from II to V for these recommendations. 3 , 16 , 17 A multicenter review examining management of pediatric femoral shaft fractures before and after release of AAOS CPG found considerable variability in treatment and adherence to the guidelines. The authors also noted an increased trend toward surgical management in patients younger than five years despite the guidelines.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Spica Casting Results in More Unplanned Reoperations than Elastic Intramedullary Nailing: A National Analysis of Femur Fractures in the Preschool Population

Brnjoš

Lyons²,

Hyman³

et al. 2020

JAAOS Glob Res Rev

View full text Add to dashboard Cite

Background: Spica casting and elastic stable intramedullary nailing (ESIN) are treatment options for femur fractures in preschool-age children. Clinical practice guidelines are only of moderate or limited strength, which may lead to variation in practice. The purpose of this study was to compare the revision surgery rate in young children undergoing these procedures. Methods: The Pediatric Health Information System, a database of 49 children hospitals, was queried for patients aged 3 to 6 years undergoing spica casting or ESIN for a diaphyseal femur fracture. ESIN removal was not considered an unplanned revision surgery because the indication for removal could not be determined in the database. Univariate analysis was followed by multivariate regression. Results: Analysis included 4,059 subjects with a mean age of 3.9 ± 1.1 years. Unplanned revision surgery was done in 227/2,878 children (8%) with a spica cast and 35/1,181 (3%) of those with ESIN ( P < 0.01). Approximately 2% of children in each cohort underwent ESIN or open reduction and internal fixation as a revision procedure ( P = 0.35). In multivariate analysis, spica casting resulted in 4.4 times higher odds of unplanned revision surgery than ESIN (95% confidence interval [CI], 2.9–6.7; P < 0.01). In the spica cast cohort, each year of increasing age resulted in 1.3 times higher odds of revision surgery (95% CI, 1.1–1.6; P < 0.01). Children who were aged 5 or 6 years at the time of spica casting had 1.9 times higher odds of requiring a subsequent procedure compared with 3- and 4-year-olds (95% CI, 1.3–2.7; P < 0.01). Conclusions: In this large, nationally representative cohort, spica casting resulted in higher odds of requiring an unplanned revision surgery than ESIN, when nail removal was not included as an unplanned procedure. Spica casting in 5- and 6-year-olds yielded higher odds of revision surgery. Regardless of whether spica casting or ESIN is chosen as the initial treatment, 2% of patients will subsequently undergo ESIN or open reduction and internal fixation as a revision procedure.

show abstract

Section: Discussionmentioning

confidence: 99%

“…They also note limited evidence to support flexible intramedullary nailing to treat children aged 5 to 11 years diagnosed with diaphyseal femur fractures. 3 The preschool-age population lies at the intersection of these recommendations, which are of moderate strength at best.…”

mentioning

confidence: 99%

Spica Casting Results in More Unplanned Reoperations than Elastic Intramedullary Nailing: A National Analysis of Femur Fractures in the Preschool Population

Brnjoš

Lyons²,

Hyman³

et al. 2020

JAAOS Glob Res Rev

View full text Add to dashboard Cite

show abstract

“…The 2015 American Academy for Orthopaedic Surgeons (AAOS) evidencebased clinical practice guidelines for the treatment of paediatric diaphyseal femoral fractures provides a limited recommendation for the use of elastic intramedullary nails in children between the ages 5 to 11 years. 8 Conservative treatment inevitably resulted in prolonged immobilisation with negative effects on the child's social development, schooling and family. [9][10][11] Increasing pressure on hospital beds lends impetus to management techniques that facilitate early mobilisation and discharge.…”

Section: Discussionmentioning

confidence: 99%

Antegrade flexible intramedullary nailing through the greater trochanter in paediatric femur shaft fractures

et al. 2019

View full text Add to dashboard Cite

Aims: To determine whether an antegrade approach, through the tip of the greater trochanter, in femoral shaft fractures in children, is safe, achieves adequate union and results in significant proximal femoral growth complications. Patients and methods: The case records and radiographs of 23 paediatric patients aged 7 to 12 years with femur shaft fractures managed with stainless steel antegrade flexible nailing were reviewed retrospectively. Pre-operative radiographs were reviewed for fracture pattern, level and comminution. Post-operative radiographs were reviewed to assess for union, alignment, osteonecrosis of the femoral head and epiphysiodesis of the greater trochanter. Morphological changes of the proximal femur were assessed by comparing the neck shaft angle and articulo-trochanteric distance with the opposite hip. Case records were reviewed for post-operative complications, patient-reported complaints and leg length discrepancy. Clinical outcomes were assessed with the criteria established by Flynn. Results: All patients achieved union, and none had evidence of osteonecrosis of the femoral head on follow-up. Three patients had malalignment and two patients had radiographic evidence of greater trochanteric epiphysiodesis. Two patients had morphological changes of the proximal femur, with one having an increased neck shaft angle and one an increased articulo-trochanteric distance. One patient had a leg length discrepancy of 2 cm. Fifteen patients had excellent clinical outcomes, five had satisfactory outcomes and three had poor outcomes according the criteria established by Flynn. Conclusion: Antegrade entry through the tip of the greater trochanter does not appear to compromise the blood supply to the femoral head or increase the risk of clinically significant morphological changes to the proximal femur. All patients achieved adequate union. Furthermore, antegrade insertion avoided skin problems and prominent nail complications around the knee seen with retrograde insertion.

show abstract

“…For example, the 2009 American Academy of Orthopaedic Surgeons clinical practice guidelines on the treatment of pediatric diaphyseal femoral fractures now recommends a NAT evaluation in all patients below 36 months of age. 11…”

Section: Introductionmentioning

confidence: 99%

Demographics and Risk Factors for Non-Accidental Orthopedic Trauma

Sivasundaram

Trivedi

Gatta

et al. 2019

Clin Pediatr (Phila)

View full text Add to dashboard Cite

Childhood non-accidental trauma (NAT) is the second most common cause of death in children. Despite its prevalence, NAT is frequently unreported due to provider misdiagnosis or unawareness. The purpose of this study was to determine current risk factors and injury patterns associated with NAT. A retrospective review of the Kids’ Inpatient Database was performed for the years 2009 and 2012. Univariate and multivariate analyses were used to determine the statistically significant risk factors for NAT. In 2009 and 2012, 174 442 children were hospitalized for fractures. Of these, 2.07% (3614) were due to NAT. Lower extremity (femur, tibia/fibula, foot), hand/carpus, clavicle, pelvis, and spine fractures were more likely to result from NAT; tibia/fibula fractures were most predictive of NAT. Children with anxiety, attention-deficit, conduct, developmental, and mood disorders were more likely to experience NAT. Those with cerebral palsy and autism were not at an increased risk for NAT.

show abstract

AAOS Clinical Practice Guideline on the Treatment of Pediatric Diaphyseal Femur Fractures

Cited by 62 publications

References 1 publication

Spica Casting Results in More Unplanned Reoperations than Elastic Intramedullary Nailing: A National Analysis of Femur Fractures in the Preschool Population

Spica Casting Results in More Unplanned Reoperations than Elastic Intramedullary Nailing: A National Analysis of Femur Fractures in the Preschool Population

Antegrade flexible intramedullary nailing through the greater trochanter in paediatric femur shaft fractures

Demographics and Risk Factors for Non-Accidental Orthopedic Trauma

Contact Info

Product

Resources

About