Elastic nail fixation versus plate fixation of paediatric femoral fractures in school age patients – A retrospective observational study

Milligan, David; Henderson, L; Tucker, Adam; Ballard, J.

doi:10.1016/j.jor.2019.11.033

Cited by 10 publications

(24 citation statements)

References 40 publications

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“…Five articles included 300 cases provided data regarding length of hospital stay. [12,15,17,19,20] No difference was found in our study (MD = −0.50;95% CI = −1.62 to 0.63, P = .39) (Fig. 3D).…”

Section: Hospital Staycontrasting

confidence: 57%

“…The remaining 8 articles involving 561 patients met the inclusion criteria and were included in this review. [8,12,[15][16][17][18][19][20] Figure 1 shows the results flow chart for the whole search process.…”

Section: Study Identification and Selectionmentioning

confidence: 99%

“…[10] In particular, for length-stable fracture patterns, the ESIN technique has been shown to have a high joint rate, require a relatively short time in a protected weight-bearing state, have limited surgical dissection, and are likely to have a shorter hospital stay compared to alternative surgical techniques. [9,11] However, ESINs are limited by higher reported complication rates consisting of unplanned reoperation, limblength discrepancy, and malunion [8,12] ; The problems were amplified in older patients and those who weighed more than 49 kg. [5] Plate osteosynthesis has a long history in the treatment of pediatric diaphyseal femur fractures.…”

Section: Introductionmentioning

confidence: 99%

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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

Hu,

Xu,

Shi

et al. 2023

Medicine

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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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Section: Hospital Staycontrasting

confidence: 57%

Section: Study Identification and Selectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

Hu,

Xu,

Shi

et al. 2023

Medicine

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“…The choice of internal fixation for subtrochanteric fractures in children depends on the type of fracture, weight, and age. Milligan et al (18) and Shah et al (19) concluded that treating subtrochanteric fractures in children, especially in overweight children with comminuted, or long oblique unstable fractures, is superior to elastic nail fixation and that internal fixation with a splint can provide strong internal fixation and achieve anatomic repositioning. Because the subtrochanteric fracture in children is located at the proximal end of the femur, the support point of the elastic intramedullary pin is far away from the fracture end and the proximal fixation space is limited, which is not favorable to maintaining the stability of the fracture end and has a higher incidence of postoperative rotation, angulation, and inversion deformity complications (20).…”

Section: Discussionmentioning

confidence: 99%

Titanium elastic nails vs locking plate in pediatric subtrochanteric femur fractures: A systematic review and meta-analysis

Zhang

Yang²,

Zhao³

et al. 2023

Front. Pediatr.

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ObjectiveTitanium elastic nails (TENs) and locking plates (LPs) are currently the main internal fixation for treating pediatric subtrochanteric femur fractures, and the optimal choice of internal fixation is controversial. This study aimed to systematically evaluate the effectiveness and safety of TENs and LPs in treating subtrochanteric fractures in children to provide a theoretical basis and reference for clinical treatment.MethodsThe literature related to TENs and LPs for treating subtrochanteric fractures in children was searched using the CNKI, PubMed, Cochrane, Embase, and Web of Science, and the search time frame was from the establishment of the database to October 2022. Two evaluators screened the literature according to the inclusion and exclusion criteria and extracted relevant data. Meta-analysis was performed using Stata14.0 software.ResultsA total of 9 studies with 407 patients with subtrochanteric femur fractures were included in the final screening, including 210 cases with TENs and 197 cases with LPs. Meta-analysis results showed that compared with the locking plate, TEN had a shorter operative time [WMD = −1.3, 95%CI(−1.94,-0.66), p < 0.01], less intraoperative bleeding [WMD = −84.45, 95%CI(−111.09, −57.82), p < 0.01], shorter fracture healing time [WMD = −1.3, 95%CI(−1.94,−0.66), P < 0.01], shorter hospital stays [WMD = −2.80, 95% CI(−4.63,−0.98), p < 0.01], and earlier full weight bearing [SMD = −0.48, 95% CI(−0.91,−0.04), p < 0.05] but more intraoperative fluoroscopy [WMD = 28.23, 95% CI(15.22,41.25), p < 0.05]. The overall complication rate was high [OR = 3.52, 95% CI(1.96,6.34), p < 0.05], and the postoperative period was prone to angulation, rotation, and inversion deformity [OR = 3.68, 95% CI(1.40, 9.68), p < 0.05]. No significant difference in the incidence of lower limb inequality between the two types of internal fixation [OR = 0.83, 95% CI(0.38, 1.85), p > 0.05] and no significant difference in the Harris score of the hip at the last follow-up between the two types of internal fixation [WMD = −0.67, 95% CI(−2.01,0.67), p > 0.05] were found.ConclusionIn comparison to LPs, TENs have a shorter operation time, less intraoperative bleeding, and a shorter fracture healing time, and the child can be fully weight-bearing earlier. Locking plates can reduce the operator's x-ray exposure, and the incidence rate of postoperative angulation, rotation, and inversion deformity is low. Therefore, TENs and LPs are the best internal fixation methods for treating subtrochanteric fractures in children.

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“…Good results are obtained in length stable fracture patterns, patients who are lighter than 50kg and after surgery with an optimal configuration of the nails in the medulla (11,12). However, some reports have associated flexible nailing with more mal union, delayed weight-bearing and healing, and hardware irritation (13,14).…”

Section: Introductionmentioning

confidence: 99%

Fixator Assisted Internal Fixation of Paediatric Femoral Fractures

Elsheikh

El‐Sayed

Kandel

et al. 2022

Benha Medical Journal

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Background: Femoral shaft fractures in children are serious injuries requiring hospitalisation. Different fixation methods were described. Aim: We present a novel technique using external fixator to facilitate and control the reduction intraoperatively, which would allow for easier sub muscular plate application. Methods: We have retrospectively reviewed five boys and five girls. Polyaxial clamps and rods were applied to the sagittally-oriented bone screws, the reduction was done manually, and the clamps were tightened after achieving the proper alignment. The sub muscular plate was applied, and then clamps and bone screws were removed. Results: The mean age at surgery was 12 years. The mean body weight was 42 kg. There were six type A fractures, two type B and two type C. The mean preoperative haemoglobin concentration was 12.29 g/dl. No blood transfusion was needed. The operative time averaged 122 minutes, and the mean hospital stay after was 2 days. The patients reported no pain at a mean of 1.6 weeks. All fractures united, without neither malalignment nor length discrepancy, at a mean of 8.3 weeks (range 6-12 weeks). Neither wound healing problems nor deep infections happened. Conclusion: External fixator-assisted internal fixation of paediatric femoral fractures would facilitate the accuracy and control of fracture reduction and allow minimally invasive percutaneous osteosynthesis.

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Elastic nail fixation versus plate fixation of paediatric femoral fractures in school age patients – A retrospective observational study

Cited by 10 publications

References 40 publications

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

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

Titanium elastic nails vs locking plate in pediatric subtrochanteric femur fractures: A systematic review and meta-analysis

Fixator Assisted Internal Fixation of Paediatric Femoral Fractures

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