Spica Casting Results in More Unplanned Reoperations than Elastic Intramedullary Nailing: A National Analysis of Femur Fractures in the Preschool Population

Brnjoš, Konstantin; Lyons, David K.; Hyman, Max J.; Patel, Neeraj M.

doi:10.5435/jaaosglobal-d-20-00169

Cited by 8 publications

(12 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The ESIN group was significantly older with an average of 4.5 years [ 13 ]. Brnjos et al found in their database research 1181 children treated with ESIN in femoral shaft fractures with an average age of 4.9 years [ 15 ]. Lewis et al reported 32 patients treated with ESIN at 5.3 years of age in average [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

ESIN in femur fractures in children under 3: is it safe?

Cintean

Eickhoff

Pankratz

et al. 2022

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Background Pediatric femur fractures are a major trauma in children. Different treatment algorithms have been developed but indications for surgical treatment, especially in very young patients, are still controversial. Literature recommends surgical stabilization with elastic-stable intramedullary nailing (ESIN) starting at the age of 3 and non-operative treatment in younger patients. This study sought to present the outcome of patients younger than 3 years of age treated with ESIN for femur fractures. Materials and methods Inclusion criteria were patients younger than 3 treated with ESIN in femur fractures. Patient demographics, fracture characteristics, mechanism of injury, outcomes and complications were recorded using charts and X-rays. Primary outcome measures were time to mobility, fracture consolidation and surgical-related complications. Results Between 2010 and 2020, 159 patients were treated with ESIN in femur fractures in our institution. A total of 30 patients met the criteria. The mean age was 2.1 ± 0.7 years (13 months–2.9 years). Most common mechanism was fall from standing height (60%). Other mechanisms were motor vehicle accidents as a pedestrian (10%) or as a passenger (10%) as well as direct blow trauma (20%). Femoral shaft fracture was the most common injury (80%). 5 subtrochanteric and one distal metaphyseal femur fractures were found. Mean length of stay was 2.0 ± 1.3 days. Radiographic controls were performed on day 1, 14 and 6 weeks after surgery if not otherwise specified or if complications occurred. 4.6 ± 1.2 (n 2–7) X-rays were performed on average after surgery. First radiographic consolidation signs were seen after 2.4 ± 0.6 weeks. Only one child showed surgical-related complication with a leg length discrepancy of 1 cm. In 10% of the patients, shortening after surgery of 1.7 ± 1.4 mm (0.3–3.1 mm) occurred. One child initially treated with traction therapy showed skin irritations and was operated with ESIN. No non-union or ESIN-related complications were found. Mean follow-up was 5.1 ± 4.4 months (4–24 months). First independent mobilization was seen at an average of 3.4 ± 1.1 weeks (2–6 weeks) after surgery. Implant removal was performed after 3.2 ± 1.3 months (2–8 months). No refracture after implant removal occurred. Conclusion Early results with ESIN show a reasonable and safe treatment option for femur fractures in toddlers and young children under the age of 3 with easy postoperative care, fast fracture union and early independent mobilization.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Ramo et al reported revision surgery in 4% of patients in both groups [ 25 ]. In a recent study, Brnjos et al reported 4.4 times more unplanned reoperations in the non-operative group [ 15 ]. In our study, we had one case of conversion into surgical treatment due to skin lesions after traction therapy.…”

Section: Discussionmentioning

confidence: 99%

ESIN in femur fractures in children under 3: is it safe?

Cintean

Eickhoff

Pankratz

et al. 2022

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

show abstract

“…Most pediatric femoral shaft fractures in children aged 5 years and older are now treated with internal fixation. 22 During middle childhood (5 to 11 years old), flexible nails are usually the most appealing option for extraphyseal fixation. Flynn et al 25 prospectively compared titanium flexible nails versus traction and a spica cast in 83 patients aged 6 to 16 years.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Treatment of Pediatric Femoral Shaft Fractures

Greenhill

Herman

2022

J Am Acad Orthop Surg

View full text Add to dashboard Cite

Diaphyseal femur fractures are common in pediatric orthopaedic settings. A patient-specific treatment plan incorporates several factors, including age, weight, fracture pattern, associated injuries, and social considerations. Nonaccidental trauma should be considered in children younger than 3 years. In general, young children are treated with noninvasive immobilization (Pavlik harness or early hip spica casting) while school-aged children are treated with internal fixation. Internal fixation options include flexible intramedullary nails, rigid locked intramedullary nails, and plate osteosynthesis. Flexible intramedullary nails have the best outcomes in children of appropriate weight, aged 5 to 11 years, with stable fracture patterns. Lateral-entry rigid intramedullary nails have been designed for use in older children. External fixation is usually reserved for complex scenarios. Regarding all treatment methods, surgeons should be aware of several technical factors necessary to optimize outcomes.

show abstract

“…Hospitalization length and financial expenses remain another issue to compare. However, there are no reported cases on the management of children with transposition of the fractured segments of the femur [ 6 , 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Impressive Remodeling of the Fractured Femur with Transposition of the Fractured Parts, Treated Conservatively with skin Traction, in a 3-Year-Old Boy

Laliotis¹,

Chrysanthou²,

Konstandinidis³

2022

JOCR

View full text Add to dashboard Cite

Introduction: Conservative management of femoral fractures in children in the preschool age is considered as the standard care. In the past years, there is an increase in the number of surgically treated children with IM nails, even in these young ages. Several papers report on the results comparing the final alignment of the fractures but there are no reports on the conservative treatment of a fracture with transposition of the fragments. Case Report: A 3-year-old boy was referred in our hospital with a spiral fracture of his right femur. There was transposition of the fragments, with the proximal part shifted medially and the distal part laterally. We informed the parents for the methods of treatment available for his fracture. After 1 week of hospitalization, the child was transferred home, with skin traction, with supervision of an orthopedic surgeon. The child was regularly evaluated with radiological examination, every 10 days. There was an uneventful healing of the fracture, with normal alignment of the leg and acceptable initial leg length discrepancy (LLD). One year after the fracture, there is an impressive remodeling of the fracture with restoration of the medullary canal and absent LLD. Conclusion: Conservative treatment of spiral fracture in a child younger than 3 years is an effective method. Remodeling in this young age can restore not only deviations on the frontal and sagittal plane but also correct the transposition of the fragments with restoration of the medullary canal.

show abstract

Spica Casting Results in More Unplanned Reoperations than Elastic Intramedullary Nailing: A National Analysis of Femur Fractures in the Preschool Population

Cited by 8 publications

References 17 publications

ESIN in femur fractures in children under 3: is it safe?

ESIN in femur fractures in children under 3: is it safe?

Treatment of Pediatric Femoral Shaft Fractures

Impressive Remodeling of the Fractured Femur with Transposition of the Fractured Parts, Treated Conservatively with skin Traction, in a 3-Year-Old Boy

Contact Info

Product

Resources

About