Epidemiology and Associated Injuries in Paediatric Femoral Shaft Fractures Treated at a Limited Resource Zonal Referral Hospital in Northern Tanzania

Abstract

Background: Femoral shaft fractures contribute up to 40% of paediatric orthopaedic admissions with the World Health Organisation data showing youth are particularly vulnerable and road traffic injuries are the leading cause of death for children and young adults. The mechanism of injury varies with age and geographical location of the patient and involves a variety of mechanisms from falls to road traffic injuries. Understanding the incidence, mechanism and pattern of these injuries allows planning for preventive measures and treatment to meet modern day patient demands, generation of appropriate and timely protocols with minimum social and economic burden to the patient and family. Objectives and Methods: A hospital based cross sectional study was conducted using the orthopaedic department patient registry among children aged under 18 years admitted from 2014 - 2018. Our research question was to determine the epidemiology of femoral shaft fractures and coexisting associated injuries among admitted paediatric orthopaedic patients. Patient files were reviewed from the medical records department and a data collecting sheet was used to record demographics and injury data. Odds ratios with 95% confidence intervals for associated injuries in paediatric femoral shaft fractures were estimated using multivariable logistic regression model.Results: We found the prevalence of femoral shaft fracture among paediatric orthopaedic admissions was 18% with the majority 111 (68.5%) being males. The most common injury mechanism was a fall (57.4%) followed by road traffic injuries with 35.8% of which 48.3% resulted from pedestrian vs motorcycle accidents. Traumatic brain injury (TBI) was the most common associated injuries accounting for 69% of these injuries with the majority 79% occurring in patients aged 6 years and older. When comparing 6-12 years and 13-18 years age groups to those younger ≤ 2 years, they had 8 and 11 times higher odds for associated injuries (OR 8.25, 95% CI, 1.04 - 65.31) p=0.046 and (OR 10.54, 95% CI, 1.26 - 88.31) p=0.031 respectively with road traffic related injuries having 17 times higher odds of associated injuries when compared to fall (OR 16.73, 95% CI, 6.28 - 44.57) p<0.001. 112 (69.1%) were treated by non-operative method out of this 90 (55.6%) by traction with delayed Spica application. The overall mean duration of hospital stay was 18.5 ± 11 days, ranging from 3 – 68 days.Conclusion: Pedestrian vs motorcycle injuries was the leading specific cause of paediatric femoral shaft fractures with TBI being the common associated injury. Non-operative management was the most utilized treatment plan and contributed to ten times higher odds for a longer duration of hospital stay. Initiatives to insure children safety on roads should be strengthened in order to reduce/eliminate this burden. Application and practice of current evidence based clinical guidelines and recommendations is paramount for timely and appropriate treatment of these injuries.

Pattern, treatment modalities and radiological outcome of pediatric femoral shaft fractures treated in Northern,Tanzania

“…In this study, non-operative treatment was commonly used in managing femoral shaft fractures in children, accounting for 50.9%, and mostly were on late hip Spica. Similar observations were seen in other studies (14,16,21) Several studies favour the use of flexible nails at ages 6 to 12 years. Flexible nails can prevent fracture rotation and maintain the length and alignment at the fracture site depending on fracture pattern (14).…”

“…In this study, the mid-shaft was the most common location of the fracture similarly observed in the study done by Hoffman et al and Guifo et al (9,19) and the majority had a closed fracture, similarly reported in Nigeria, and Tanzania (3,16).…”

“…The minimum sample size was 225 patients calculated using the single proportion with an assumption of 18% prevalence obtained from the study done at KCMC (16); however, this study enrolled 230 study participants. A non-probability, convenient sampling technique was used, hence all paediatric patients with femoral shaft fractures treated at KCMC and registered in admission and trauma registry books during the study period were included in the study.…”

“…The minimum sample size was 225 patients calculated using the single proportion with an assumption of 18% prevalence obtained from the study done at KCMC (16); however, this study enrolled 230 study participants. Therefore the estimated sample size (n) was 225; this study enrolled 230 study participants.…”