Femoral Fractures in Adolescents: A Comparison of Four Methods of Fixation

Ramseier, Leonhard E.; Janicki, Joseph A.; Weir, Shannon; Narayanan, Unni G.

doi:10.2106/jbjs.h.01735

Cited by 78 publications

(59 citation statements)

References 25 publications

(22 reference statements)

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“…This corroborates with other studies [1,21,22,29,37,42,43]. However, we would like to highlight one patient (age 64 years) who presented with a MAD of 55 mm lateral and a dynamic deformity with joint line obliquity and lax collateral ligaments.…”

Section: Discussionsupporting

confidence: 92%

“…Our results are corroborated by Keast-Butler and Schemitsch's review of fixation techniques, where they found no evidence supporting internal fixation with plates over external fixation after distal radial fractures [10]. We report a smaller complication profile compared with fracture studies [2,29,32] which suggest definitive treatment of femoral fractures with external fixation is associated with nonunion in 9% to 20% of patients, deep pin track infections in 6% to 20%, and knee stiffness in 0% to 45%, whereas a systematic literature review by Zlowodzki et al [43] (n = 327) found that average nonunion, fixation failure, deep infection, and secondary surgery rates were 5.5%, 4.9%, 2.1%, and 16.2%, respectively. Fixation failure has been attributed to waiting too long to bone graft defects, premature weightbearing, and placing the plate too anterior on the femoral shaft [4,36,37].…”

Section: Discussionsupporting

confidence: 85%

See 1 more Smart Citation

Distal Femoral Osteotomy: Is Internal Fixation Better than External?

Seah

Shafi

Fragomen

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 85%

Distal Femoral Osteotomy: Is Internal Fixation Better than External?

Seah

Shafi

Fragomen

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…The literature has compared operative outcomes in femoral shaft fractures in the skeletally immature child. However, these studies have largely focused on the adolescent population, 10,22 and few data are available on younger cohorts. The current study compared 3 surgical methods of fixation in skeletally immature children 8 years and older.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Diaphyseal Femur Fractures: Submuscular Plating Compared With Intramedullary Nailing

Sutphen¹,

Mendoza²,

Mundy³

et al. 2016

Orthopedics

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This study compared the radiographic and clinical outcomes of pediatric diaphyseal femur fractures treated by submuscular plating, flexible retrograde intramedullary nailing, or rigid antegrade intramedullary nailing with a trochanteric entry point in skeletally immature patients who were 8 years and older. A retrospective review was conducted of skeletally immature patients 8 years and older who were treated for femur fracture with submuscular plating, flexible intramedullary nailing, or rigid intramedullary nailing from 2001 to 2014 with a minimum 12-week follow-up. Treatment outcomes were compared for statistical significance, including time to union, malunion, nonunion, heterotopic ossification, avascular necrosis, time to full weight bearing, limb length discrepancy, residual limp, painful hardware, and infection. The study identified 198 femur fractures in 196 patients (mean age, 11.9 years). Each femur fracture was treated with submuscular plating (35), flexible intramedullary nailing (61), or rigid intramedullary nailing (102). Mean follow-up across the cohort was 48 weeks, ranging from 12 to 225 weeks. Flexible nailing was associated with an increased incidence of malunion (P<.0001) and hardware irritation (P=.0204) and longer time to full weight bearing (P=.0018). Rigid nailing was associated with an increased incidence of limp at 12-week followup (P=.0412). Additionally, 23.5% of patients who were treated with rigid nailing had heterotopic ossification. Of all surgical methods, submuscular plating allowed for the most rapid return to full weight bearing (mean, 7 weeks) and offered the fastest healing rate (mean, 6 weeks). Submuscular plating resulted in faster times to union and full weight bearing, with minimal complication rates. Rigid intramedullary nailing with trochanteric entry resulted in a lower incidence of malunion and hardware-related complications; however, these patients had an increased incidence of heterotopic ossification and residual limp postoperatively. Flexible retrograde intramedullary nailing resulted in the highest rates of malunion and hardware irritation and the longest time to full weight bearing. [Orthopedics. 2016; 39(6):353-358.].

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“…With all surgical methods available, the choice of fixation is according to surgeons' preference on the basis of expertise and experience, patient and fracture characteristics, and patient and family preferences [42]. As already mentioned, the disadvantages of conservative management in this age group are multiple and thus this form of treatment cannot be considered an optimal treatment.…”

Section: Discussionmentioning

confidence: 99%

External fixation of pediatric femoral shaft fractures

Wani

Dar

Latoo

et al. 2013

Journal of Pediatric Orthopaedics B

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Forty-five displaced femur fractures in children were treated with unilateral external fixation as a standard treatment from March 2007 to March 2009 and the last follow-up was completed in May 2012. The average age of the children at presentation was 9.93 years. Patients were followed up till union, at 1 year, and at an average of 3.5 years after fixation. The fixator was removed at an average of 12.23 weeks. Twenty-one (47%) patients had a minor complication of pin-site infection. One patient had a major complication of refracture. Treatment of uncomplicated femur fractures using an external fixator in children yields satisfactory results. Our series had a longer duration of follow-up and fewer refractures compared with other series.

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Femoral Fractures in Adolescents: A Comparison of Four Methods of Fixation

Cited by 78 publications

References 25 publications

Distal Femoral Osteotomy: Is Internal Fixation Better than External?

Distal Femoral Osteotomy: Is Internal Fixation Better than External?

Pediatric Diaphyseal Femur Fractures: Submuscular Plating Compared With Intramedullary Nailing

External fixation of pediatric femoral shaft fractures

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