Interventions for treating femoral shaft fractures in children and adolescents

Madhuri, Vrisha; Dutt, Vivek; Gahukamble, Abhay; Tharyan, Prathap

doi:10.1002/14651858.cd009076.pub2

Cited by 33 publications

(25 citation statements)

References 29 publications

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“…Complication rates after ESINF have been associated with the severity of the comminution and the fracture stability . In our study, neither the extent of the comminution nor the fracture pattern had a significant association with loss of reduction or malunion in the ESINF group.…”

Section: Discussioncontrasting

confidence: 63%

Comparison of three fixation methods in treatment of tibial fracture in adolescents

Liu

Lin

et al. 2017

ANZ Journal of Surgery

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All three treatments had satisfactory outcomes, and EF was correlated with the highest rate of complications in our series of adolescents treated with a tibial fracture. However, we cannot currently recommend that all fractures might be suitable for ESINF. The choice of fixation will remain influenced by surgeon preference in term of expertise and experience, patient and fracture characteristics, and patients and family preferences.

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Section: Discussioncontrasting

confidence: 63%

Comparison of three fixation methods in treatment of tibial fracture in adolescents

Liu

Lin

et al. 2017

ANZ Journal of Surgery

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“…In our study, the low mean age of participants (4.2 ± 3.3 years), the low rate of associated injuries (4/29 children) and the high proportion of closed simple diaphyseal non displaced fractures (23/30 cases) were already highly suggestive that there should be greater indication of a conservative approach in fracture management. Although with low quality evidence, a recent meta-analysis of randomized controlled trials concluded that compared to conservative treatment, elastic intramedullary nailing may shorten rehabilitation time [5]. The benefits of a speed up recovery cannot be over emphasized, given our observed longer durations of immobilization (p < 0.0001) and consolidation (p < 0.0001) in school-aged children compared to preschool children.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence from a recent systematic review of randomized controlled trials did not ascertain the efficacy of conservative management over surgical management of femoral shaft fractures and vice versa, in terms of long-term functional outcome [5]. The choice between conservative and surgical treatment has traditionally been multifactorial, influenced by age and weight of the child, associated injuries, the fracture characteristics, institutional or surgeons' preferences, economic and social concerns [5-7]. Due to rapid bone remodelling, most of the femoral fractures in children younger than six years can be managed conservatively by traction and plaster-cast immobilization [8].…”

Section: Introductionmentioning

confidence: 99%

A Prospective Cohort Study of the Therapeutic Patterns, Challenges and Outcomes of Paediatric Femoral Fractures in a Cameroonian Tertiary Center

Tochie¹,

Guifo²,

Yamben³

et al. 2017

TOORTHJ

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Background:Knowledge of the therapeutic patterns, challenges and outcomes of treatment of paediatric femoral fractures (PFF) helps to better choose the ideal therapeutic modality which is still controversial. However, this data is scarce in the sub-Saharan African literature.Objective:To determine the therapeutic patterns, treatment challenges and outcomes of treatment of PFF in a tertiary care centre in Cameroon.Method:We conducted a prospective cohort study of all consenting consecutive cases of femoral fractures in patients younger than 16 years managed between 2011 and 2015 at the surgical unit of Yaoundé University Teaching Hospital, Cameroon. We analysed demographic data, injury characteristics, fracture patterns, treatment details, therapeutic challenges and outcomes of treatment at 12 months using Flynn’s criteria.Results:We enrolled 30 femoral fractures from 29 children with mean age was 4.2 ± 3.3 years. The male gender, diaphyseal locations and spiral fracture lines were predominant. Main mechanisms of injury were accidental falls, road traffic accidents and game injuries. Fracture management entailed 12 tractions followed by casting, 10 casting alone, four closed reductions followed by casting, two cannulated screw fixations, one pin fixation and one external fixation. The mean duration of consolidation was 10.3 ± 3.9 weeks. The outcome was rated excellent in 28 cases. Limited resources precluded fluoroscopy use, proper anaesthetic management, early rehabilitation and patient-parent satisfaction.Conclusion:Conservative management of PFF yields a good outcome in our setting. However, an improvement in surgical, radiology and anaesthetic infrastructure is needed for optimal PFF care.

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“…Orthopedic management of pediatric femur fractures is variable depending on patient age, fracture characteristics, and available resources. 1 These fractures can cause significant bleeding into the thigh, requiring emergent traction and splinting to reduce intravascular blood loss. Pain management in this setting can be challenging because quadriceps muscles tend to spasm during patient movement, resulting in marked increases in pain.…”

Section: Learning Objectivesmentioning

confidence: 99%

Ultrasound-Guided Femoral Nerve Blocks

Baker

Gullett

2015

Pediatric Emergency Care

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Pediatric acute femur fractures are a relatively common major orthopedic injury seen in emergency departments. Providing adequate and safe analgesia is essential while patients await definitive management of these fractures. Opioid medications are typically used to treat fracture-associated pain but have well-known adverse effects including respiratory and central nervous system depression, pruritus, nausea, and allergic reactions. Dose titration of opioids in pediatric patients may be difficult and requires frequent nursing and physician reassessments. Regional anesthesia using ultrasound guidance has been proposed as a reliable and safe method to provide pain relief for this population and to decrease reliance on opioid medications. There is a growing body of literature on the utility and safety of ultrasound-guided femoral nerve blocks for pediatric patients in the acute care setting. This review article covers recent literature on point-of-care ultrasound-guided femoral nerve blocks for pediatric patients, with a discussion of the indications, sonographic anatomy, selection of anesthetics, nerve block technique, and complications. This review supplements the expert supervision and practice required to gain competency.

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Interventions for treating femoral shaft fractures in children and adolescents

Abstract: Interventions for treating femoral shaft fractures in children and adolescents (Review)

Cited by 33 publications

References 29 publications

Comparison of three fixation methods in treatment of tibial fracture in adolescents

Comparison of three fixation methods in treatment of tibial fracture in adolescents

A Prospective Cohort Study of the Therapeutic Patterns, Challenges and Outcomes of Paediatric Femoral Fractures in a Cameroonian Tertiary Center

Ultrasound-Guided Femoral Nerve Blocks

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