Operative Choice for Length-Unstable Femoral Shaft Fracture in School-Aged Children: Locking Plate vs. Monolateral External Fixator

Hong, Pan; Rai, Saroj; Tang, Xin; Liu, Ruikang; Li, Jin

doi:10.3389/fped.2021.799487

Cited by 3 publications

(4 citation statements)

References 35 publications

(39 reference statements)

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“…The global ring inconsistency test was performed for the studies involved (P = 0.775 > 0.05), and the local inconsistency test was performed using the node-splitting method, as shown in Table 2.a, the results were not signi cant, and the consistency model could be used for analysis. Figure 4 shows the result evaluation system for the length of hospital stay, of which Figure 4 (a) is the evidence network diagram for the length of hospital stay, which shows that this outcome measure involves four treatment measures including plate, traction (plaster), external xation and intramedullary nailing and involving a total of 17 studies [5,17,18,20,[23][24][25][26][27][28][29][30][31][32][33][34]36] . The global ring inconsistency test was performed for the studies involved (P = 0.300 > 0.05), and the local inconsistency test was performed using the node-splitting method, as shown in Table 3.a, the results were not signi cant, and the consistency model could be used for analysis.…”

Section: Results Of Network Meta-analysis 231 Surgical Durationmentioning

confidence: 99%

Treatment of Femoral shaft fractures in Children: A Network Meta-analysis

Zhao,

Zhou,

Meng

2024

Preprint

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Objective: This study aims to assess the efficacy of traction (plaster), intramedullary nail, plate, and external fixation in treating femoral shaft fractures in children using network meta-analysis to guide clinical decision-making. Methods: From inception to April 29, 2022, PubMed, EMbase, Cochrane Library, and Web of Science databases were searched for RCTs and cohort studies comparing treatments for femoral shaft fractures. STATA15.1 and Review Manager 5.4 software were used for data synthesis and quality evaluation. Results: Finally, 29 studies were included. Network meta-analysis findings: (1) Traction (plaster), external fixation, and intramedullary nailing were superior to plate in operation length. (2) External fixation had the best outcomes in hospital stays, with no statistically significant differences among treatments. (3) Intramedullary nailing showed significant superiority over plate in blood loss. (4) Intramedullary nailing had the best Flynn score efficacy, but the differences were not statistically significant. (5) Intramedullary nailing and plate had significantly fewer adverse events than external fixation and traction (cast). Conclusion: Comparing intramedullary nailing to traction (plaster), external fixation, and plate may enhance clinical outcomes of femoral shaft fractures in children. Intramedullary nailing may also reduce blood transfusion requirements and postoperative complications.

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Section: Results Of Network Meta-analysis 231 Surgical Durationmentioning

confidence: 99%

Treatment of Femoral shaft fractures in Children: A Network Meta-analysis

Zhao,

Zhou,

Meng

2024

Preprint

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“…The mean duration of hospitalization was 3.7 ± 1.4 days (range, 2-7). The mean follow-up time was 21.8 ± 2.7 months (range, [18][19][20][21][22][23][24][25][26][27][28][29][30].…”

Section: Resultsmentioning

confidence: 99%

“…In our study, only one patient developed knee joint stiffness. However, active knee exercises were partially hampered by the size of the quadriceps femoris, which, given its anatomic location envelops the femoral diaphysis, increasing friction between the muscle and Schanz's pin ( 27 ). However, the EF was routinely removed at 4–8 weeks postoperatively, and active exercises were encouraged to recover full knee joint ROM.…”

Section: Discussionmentioning

confidence: 99%

Elastic Stable Intramedullary Nailing and Temporary External Fixation for the Treatment of Unstable Femoral Shaft Fractures in Children Aged 5-11 Years Old: A Retrospective Study of 28 Cases

Canavese²,

Lin³

et al. 2022

Front. Pediatr.

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PurposeUnstable femoral shaft fractures (UFSFs) in children aged 5–11 years remain challenging due to their intrinsic instability. The aim of this study was to evaluate the clinical and radiographic outcomes of UFSF in children aged 5 to 11 years managed by the combined use of ESIN and temporary EF.MethodsChildren with UFSF (long oblique and comminuted) treated by ESIN and temporary EF were retrospectively reviewed. Sex, age at injury, side involved, type of fracture, presence or absence of associated lesions or neurovascular complications, type of treatment, time from trauma to surgery, duration of surgery, radiation exposure and length of postoperative immobilization were collected from the medical charts. Radiological and functional outcomes were evaluated according to Beaty's and Flynn's criteria, respectively.ResultsA total of 28 consecutive patients with closed or open (Gustilo type I or II) UFSF were reviewed (18 boys and 10 girls). The mean age at injury was 8.7 ± 1.6 years (range, 5–11); the average weight was 38.1 ± 7.6 kg (range, 26–55). The mean hospital stay was 3.7 ± 1.4 days (range, 2–7), and the mean time to EF and ESIN removal was 6.5 ± 1.1 weeks (range, 4–8) and 9.4 ± 1.6 months (range, 6–12), respectively. Twenty-seven out of 28 patients had excellent radiographic outcomes according to Beaty's criteria, and 24/28 had excellent functional outcomes according to Flynn's criteria. Overall, 4 complications (14.3%) were recorded. No statistically significant correlation was found between complication rates and sex, age, weight or fracture characteristics (P < 0.05).ConclusionsThe combined use of ESIN and temporary EF provides good clinical and radiological outcomes in children with UFSF aged between 5 and 11 years, with a reduced complication rate.

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“…Still, because the children have relatively smaller weight and height than adults, the eight-hole plate with the dimension of 135 × 16 × 5 m 3 is similar to the Synthes 4.5 mm Narrow LCP locking plate, which is children-suitable [27]. The single-locking plate system is more widely used to threaten femoral shaft fractures in children than a dual-locking plate configuration [11,28]. Nevertheless, some authors suggest using dual-locking plate configurations to increase allograft stability and avoid fixation failure [22,26,29].…”

Section: Discussionmentioning

confidence: 99%

Effect of Plate Configuration in the Primary Stability of Osteotomies and Biological Reconstructions of Femoral Defects: Finite-Element Study

Neto,

Paulino,

Amaro

2024

Bioengineering

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Background/objective: Osteosynthesis is an alternative treatment for stabilizing femur-bone traumas. The initial stability of the fixation systems is one of the biomechanical parameters affecting implant failure and bone union, especially in surgeries of intercalary reconstructions after the removal of bone tumors. This study aimed to investigate the initial biomechanical effect of using one or two osteosynthesis plate configurations for femoral fixation and the effect of fastening the allograft to the osteosynthesis plate in the case of femoral allograft reconstructions. Methods: Three finite-element models of a femur with three different fixation conditions for a transverse osteotomy in the middle of the diaphysis, i.e., using one and two osteosynthesis plates and an intercalary allograft, were constructed. An eight-hole compression plate and a six-hole second plate were used to simulate osteosynthesis plates. The plate screws were tightened previously to the loading, and the tightening sequences simulate the bolt-tightening procedure in a surgical environment. The models were imported into the ADINA System for nonlinear analysis, using compression loads applied over the femur head. Results: Models with the dual fixation systems had the most outstanding compression stiffness. The femur head movement in the dual plate system was 24.8% smaller than in the single plate system. A statistical analysis of a region of interest (VOI) placed in the femur diaphysis showed that the biomechanical effect of using the dual plate system is smaller in the osteotomy region than at the femur head, e.g., a displacement average decrease of only 5% between the two systems, while the maximum value decreases by 26.8%. The allograft fixation to the second osteosynthesis plate leads to an improvement in the system stability. Conclusions: The results presented in this work show that including the bolt analysis in the femoral diaphysis osteotomy fixation will allow for capturing the nonlinear behavior of the osteotomy region more realistically. The stability of the intercalary reconstruction of the femoral diaphysis was higher when the allograft was fastened to the second osteosynthesis plate.

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Operative Choice for Length-Unstable Femoral Shaft Fracture in School-Aged Children: Locking Plate vs. Monolateral External Fixator

Cited by 3 publications

References 35 publications

Treatment of Femoral shaft fractures in Children: A Network Meta-analysis

Treatment of Femoral shaft fractures in Children: A Network Meta-analysis

Elastic Stable Intramedullary Nailing and Temporary External Fixation for the Treatment of Unstable Femoral Shaft Fractures in Children Aged 5-11 Years Old: A Retrospective Study of 28 Cases

Effect of Plate Configuration in the Primary Stability of Osteotomies and Biological Reconstructions of Femoral Defects: Finite-Element Study

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