Risk factors for limb overgrowth after the application of titanium elastic nailing in the treatment of pediatric femoral fracture

Dai, Cheng-Qian; Yang, Jie; Guo, Xiaoshan; Lee, Sun

doi:10.1007/s00776-015-0739-z

Cited by 12 publications

(10 citation statements)

References 20 publications

(23 reference statements)

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“…A number of studies have reported overgrowth and its risk factors after femur shaft fracture in children [17,[22][23][24]. They found that length-unstable fracture, low nailto-canal diameter ratio, and younger age were associated with overgrowth after a pediatric femur shaft fracture.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have investigated the risk factors associated with overgrowth after pediatric femur shaft fracture, which included age, fracture site, fracture stability, and nail-to-canal diameter ratio [17,[20][21][22][23][24][25][26]. However, few studies have analyzed the risk factors for LLD and overgrowth after a tibial shaft fracture in children.…”

Section: Open Accessmentioning

confidence: 99%

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Leg length discrepancy, overgrowth, and associated risk factors after a pediatric tibial shaft fracture

et al. 2021

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Background This study was performed to investigate leg length discrepancy (LLD), overgrowth, and associated risk factors after pediatric tibial shaft fractures. Materials and methods This study included 103 patients younger than 14 years of age (mean age 7.1 years; 75 boys, 28 girls) with unilateral tibial shaft fracture and a minimum follow-up of 24 months. LLD was calculated as the difference between the lengths of the injured and uninjured limbs. Overgrowth was calculated by adding the fracture site shortening from the LLD. Risk factors were assessed in patients with LLD < 1 cm and ≥ 1 cm and overgrowth < 1 cm and ≥ 1 cm. Results Casting and titanium elastic nailing (TEN) were performed on 64 and 39 patients, respectively. The mean LLD and overgrowth were 5.6 and 6.4 mm, respectively. There were significant differences in sex (p = 0.018), age (p = 0.041), fibular involvement (p = 0.005), injury mechanism (p = 0.006), and treatment methods (p < 0.001) between patients with LLDs < 1 cm and ≥ 1 cm. There were significant differences in sex (p = 0.029), fibular involvement (p = 0.002), injury mechanism (p = 0.008), and treatment methods (p < 0.001) between patients with overgrowth < 1 cm and ≥ 1 cm. Sex and treatment methods were risk factors associated with LLD ≥ 1 cm and overgrowth ≥ 1 cm following pediatric tibial shaft fracture. The boys had a 7.4-fold higher risk of LLD ≥ 1 cm and 5.4-fold higher risk of overgrowth ≥ 1 cm than the girls. Patients who underwent TEN had a 4.3-fold higher risk of LLD ≥ 1 cm and 4.8-fold higher risk of overgrowth ≥ 1 cm than those treated by casting. Conclusions Patients undergoing TEN showed greater LLD and overgrowth than those undergoing casting, with boys showing greater LLD and overgrowth than girls. Surgeons should consider the possibility of LLD and overgrowth after pediatric tibial shaft fractures, especially when performing TEN for boys. Level of evidence Level III

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Section: Discussionmentioning

confidence: 99%

Section: Open Accessmentioning

confidence: 99%

Leg length discrepancy, overgrowth, and associated risk factors after a pediatric tibial shaft fracture

et al. 2021

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“…Park et al 20 reported that a length-unstable fracture was a risk factor for overgrowth in patients who underwent TEN or submuscular plating. Dai et al 22 found that length-unstable fractures and low NCD ratios (< 0.8) were significantly associated with limb overgrowth after the application of TEN. Park et al 21 also showed that a low NCD ratio (< 0.8) was a risk factor for femoral overgrowth after TEN.…”

Section: Discussionmentioning

confidence: 99%

Leg-length discrepancy and associated risk factors after paediatric femur shaft fracture: A multicentre study

Kim

Park

Lee

et al. 2021

Journal of Children's Orthopaedics

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Purpose This study was performed to investigate leg-length discrepancy (LLD) and associated risk factors after paediatric femur shaft fractures. Methods A total of 72 consecutive patients under 13 years old (mean age 6.7 years; 48 boys, 24 girls) with unilateral femur shaft fracture, and a minimum follow-up of 18 months, were included. The amount of LLD was calculated by subtracting the length of the uninjured from that of the injured limb. Risk factors for an LLD ≥ 1 cm and ≥ 2 cm were analyzed using multivariable logistic regression analysis. Results Hip spica casting, titanium elastic nailing and plating were performed on 22, 40 and ten patients, respectively. The mean LLD was 7.8 mm (sd 8.8) and 29 (40.3%) had a LLD of ≥ 1 cm, while nine (12.5%) had a LLD of ≥ 2 cm. There were significant differences in fracture stability (p = 0.005) and treatment methods (p = 0.011) between patients with LLD < 1 cm and ≥ 1 cm. There were significant differences in fracture site shortening (p < 0.001) and LLD (p < 0.001) between patients with length-stable and length-unstable fractures. Fracture stability was the only factor associated with LLD ≥ 1 cm (odds ratio of 4.0; p = 0.020) in the multivariable analysis. Conclusion This study demonstrated that fracture stability was significantly associated with LLD after paediatric femur shaft fractures. Therefore, the surgeon should consider the possibility of LLD after length-stable femur shaft fracture in children. Level of Evidence Prognostic level III

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“…There was overgrowth of the affected femur in 2 patients ; this phenomenon has been widely reported in the traumatised femur. While the exact mechanism is not clear, it has been attributed to factors such as increased vascularity and endocrine activity following trauma or surgery around the skeletally immature femur (14)(15)(16). The overgrowth of the tibia recorded in a single patient after proximal tibia resection maybe due to the same phenomenon, or excessive lengthening of the endoprosthesis.…”

Section: Discussionmentioning

confidence: 99%

Femoral bone growth after extendible endoprosthetic replacement of the proximal tibia in skeletally immature patients

Idowu¹,

Babalola²,

Abudu³

2021

Acta Orthop Belg

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There is increasing preference for limb salvage techniques in the management of pediatric musculo- skeletal tumors. This study was aimed at evaluating femoral growth following proximal tibia resection (PTR) and placement of an extendible endoprosthesis with sliding stem. This was a retrospective study. The demographic and clinical data were collected. All the patients with malignant tumors were fully staged and commenced on appropriate chemotherapy. An expected discrepancy of > 3cm was considered sub- stantial enough to warrant extendible prosthesis. Twelve patients who had follow up full length scanogram of the lower limbs were included for the evaluation of femoral growth. The last available scanograms were used for growth comparison of the femur. The age at resection for all twelve patients ranged from 4-13 years. The commonest histological diagnosis was Osteosarcoma. In the twelve patients assessed for the growth of femur, the mean femoral length was 96% [89%-102%] of the unaffected femur. Distal femoral physeal growth continued after im- plantation of a sliding extendible prosthesis after resection of proximal tibia tumors.

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Risk factors for limb overgrowth after the application of titanium elastic nailing in the treatment of pediatric femoral fracture

Cited by 12 publications

References 20 publications

Leg length discrepancy, overgrowth, and associated risk factors after a pediatric tibial shaft fracture

Leg length discrepancy, overgrowth, and associated risk factors after a pediatric tibial shaft fracture

Leg-length discrepancy and associated risk factors after paediatric femur shaft fracture: A multicentre study

Femoral bone growth after extendible endoprosthetic replacement of the proximal tibia in skeletally immature patients

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