The safety of titanium elastic nailing in preschool femur fractures

Assaghir, Yasser

doi:10.1097/bpb.0b013e328360266e

Cited by 20 publications

(27 citation statements)

References 27 publications

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“…ESIN resulted in better fracture length and alignment, as well as earlier weight-bearing and return to nursery. 6 Finally, Ramo et al 11 reported similar rates of unplanned revision surgery in their cohort of 262 patients, with 4% in both groups returning to the operating room. Although these studies are important additions to the literature on this topic, they may be underpowered to detect statistically notable differences in the revision surgery rate.…”

Section: Discussionmentioning

confidence: 86%

“…Potential advantages of ESIN are quicker mobilization and return to activities, more stable fixation with possibly less malunion and greater ease of care. 6 , 8 , 10 , 11 Disadvantages are that it is a more invasive surgical procedure that may require a second operation for implant removal and that the estimated immediate costs are higher compared with spica. 9 , 12 , 13 Spica casting is less invasive and has a lower estimated immediate cost.…”

Section: Discussionmentioning

confidence: 99%

“…This age range was chosen based, in part, on the previous literature on the subject so that the study would be comparable with previous reports. 6 , 8 , 9 The database was first queried for all Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes related to a femur fracture in this age group, yielding 5,521 subjects. Next, all patients with procedural or diagnosis codes indicative of nondiaphyseal fractures were excluded (ie, proximal, distal, or physeal fractures).…”

Section: Methodsmentioning

confidence: 99%

“…Spica casting may also result in increased time away from work and school. 4 , 5 ESIN may yield lower rates of malunion, earlier ambulation, and improved functional outcomes compared with spica casting 6 , 7 but is a more invasive procedure, can require a second operation for implant removal, and likely has higher hospital-related costs.…”

mentioning

confidence: 99%

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

Brnjoš

Lyons²,

Hyman³

et al. 2020

JAAOS Glob Res Rev

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Background: Spica casting and elastic stable intramedullary nailing (ESIN) are treatment options for femur fractures in preschool-age children. Clinical practice guidelines are only of moderate or limited strength, which may lead to variation in practice. The purpose of this study was to compare the revision surgery rate in young children undergoing these procedures. Methods: The Pediatric Health Information System, a database of 49 children hospitals, was queried for patients aged 3 to 6 years undergoing spica casting or ESIN for a diaphyseal femur fracture. ESIN removal was not considered an unplanned revision surgery because the indication for removal could not be determined in the database. Univariate analysis was followed by multivariate regression. Results: Analysis included 4,059 subjects with a mean age of 3.9 ± 1.1 years. Unplanned revision surgery was done in 227/2,878 children (8%) with a spica cast and 35/1,181 (3%) of those with ESIN ( P < 0.01). Approximately 2% of children in each cohort underwent ESIN or open reduction and internal fixation as a revision procedure ( P = 0.35). In multivariate analysis, spica casting resulted in 4.4 times higher odds of unplanned revision surgery than ESIN (95% confidence interval [CI], 2.9–6.7; P < 0.01). In the spica cast cohort, each year of increasing age resulted in 1.3 times higher odds of revision surgery (95% CI, 1.1–1.6; P < 0.01). Children who were aged 5 or 6 years at the time of spica casting had 1.9 times higher odds of requiring a subsequent procedure compared with 3- and 4-year-olds (95% CI, 1.3–2.7; P < 0.01). Conclusions: In this large, nationally representative cohort, spica casting resulted in higher odds of requiring an unplanned revision surgery than ESIN, when nail removal was not included as an unplanned procedure. Spica casting in 5- and 6-year-olds yielded higher odds of revision surgery. Regardless of whether spica casting or ESIN is chosen as the initial treatment, 2% of patients will subsequently undergo ESIN or open reduction and internal fixation as a revision procedure.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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

Brnjoš

Lyons²,

Hyman³

et al. 2020

JAAOS Glob Res Rev

View full text Add to dashboard Cite

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“… 12 - 14 Most of the overgrowth has been shown to occur within the first 18 months following the fracture. 15 - 17 It is believed that this is due to a physiological process associated with post-traumatic activation of the growth plate. 18 The mean overgrowth is approximately 1 cm and thus a proper amount of bayonet apposition is required for hip spica casting in young children.…”

Section: Introductionmentioning

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

Cintean

Eickhoff

Pankratz

et al. 2022

Eur J Trauma Emerg Surg

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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.

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The safety of titanium elastic nailing in preschool femur fractures

Cited by 20 publications

References 27 publications

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

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

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

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

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