The Use of External Fixators in Femur Fractures in Children

Sanctis, N. de; Gambardella, Alessio; Pempinello, C.; Mallano, P.; Corte, S. Della

doi:10.1097/01241398-199609000-00013

Cited by 44 publications

(12 citation statements)

References 11 publications

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“…However, external fixation allows fracture stabilization through percutaneous means while sparing the physis. The high proportion of patients whose fractures healed in this study was consistent with other studies on external fixation [3,4,7,9,10,14,18] and is comparable to that of studies using internal fixation techniques [2].…”

Section: Discussionsupporting

confidence: 81%

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External Fixation for Closed Pediatric Femoral Shaft Fractures: Where Are We Now?

Kong

Sabharwal

2014

Clin Orthop Relat Res

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Background Recent advances in external fixation technique and pin design have sought to minimize complications such as pin site infection and premature removal of the external fixator. Although newer forms of internal fixation have gained popularity, external fixation may still have a role in managing pediatric femoral shaft fractures. Questions/purposes We sought to assess the time to healing, limb alignment, and complications observed in a cohort of pediatric patients with closed femoral shaft fractures who were treated with external fixation. Methods Over a 15-year period, one surgeon treated 289 pediatric patients with femur fractures, 31 (11%) of whom received an external fixator. The general indications for use of an external fixator during the period in question included length-unstable fractures, metadiaphyseal location, refracture, and pathologic fracture. Six patients (19%) had inadequate followup data and four patients (13%) were treated with a combination of flexible intramedullary nails and external fixation, leaving 21 patients for analysis. Mean age at injury was 10 years (range, 6-15 years) and followup averaged 22 months (range, 5-45 months) after removal of the fixator. Radiographs were examined for alignment and limb length discrepancy. Complications were recorded from a chart review. Results Mean time in the fixator was 17 weeks (range, 9-24 weeks). One patient sustained a refracture and one patient with an isolated femur fracture had a leg length discrepancy [ 2 cm. There were no pin site infections requiring intravenous antibiotics or additional surgery. One patient with Blount disease and previous tibial osteotomy developed transient peroneal nerve palsy. Conclusions Despite improvements in pin design and predictable fracture healing, complications such as refracture and leg length discrepancy after external fixation of pediatric femoral shaft fractures can occur. However, external fixation remains a viable alternative for certain fractures such as length-unstable fractures, metadiaphyseal location, pathologic fractures, and refractures.

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Section: Discussionsupporting

confidence: 81%

“…Our 5% frequency of residual angular deformity (one of the 21 patients) is on the lower end of the reported risk of 3% to 19% [3,4,7,9,10,14,18]. Interestingly, our case had apex anterior angulation with near normal frontal plane alignment.…”

Section: Discussionmentioning

confidence: 86%

External Fixation for Closed Pediatric Femoral Shaft Fractures: Where Are We Now?

Kong

Sabharwal

2014

Clin Orthop Relat Res

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“…This limit is arbitrary (de Sanctis et al 1996) and, as can be seen in Tables 1 and 2, the lower limit can be around 3 years with the same good results. For elastic nails, it is the diameter of the nails and the intramedullary canal that set the limits.…”

Section: Agesupporting

confidence: 48%

Surgical treatment of femoral fractures in childrenComparison between external fixation and elastic intramedullary nails: A review

Hedin¹

2004

Acta Orthopaedica Scandinavica

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“…All patients had more than 24 months of remaining growth after Ilizarov treatment. The decision to select this time was because bony interventions or fractures of the limb may lead to locally, although temporarily (less than 2 years) increased growth (Stephens et al 1989, De Sanctis et al 1996). Since we wanted to know whether knee joint distraction had any additional effect on the growth pattern, we had to look beyond 2 years after the start of the treatment.…”

Section: Methodsmentioning

confidence: 99%

Growth rate after limb deformity correction by the Ilizarov method with or without knee joint distraction

2009

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Background and purpose Growth inhibition and stimulation have both been reported after juvenile limb lengthening. Distraction of a joint usually suspends and unloads the growth plate and may stimulate growth. We investigated the influence of knee joint distraction on the speed of growth after limb lengthening.Methods In a retrospective study, growth patterns were analyzed in 30 children mean 61 (24–109) months after limb lengthening with the Ilizarov method, each child having more than 2 years of remaining growth. In 14 patients with knee joint instability, the knee was bridged over during lengthening for joint stabilization. Whether or not joint bridging and distraction would affect patterns of growth of the lengthened limb by unloading the growth plate was evaluated with a repeated measurements analysis of variance.Results After lengthening procedures, the proportionate leg-length discrepancy was found to decrease in 16 children, suggesting increased growth rate in the lengthened limbs. A statistically significantly faster growth rate was seen in 8 of 14 patients with knee distraction as compared to patients with single bone frame configurations.Interpretation Further research is required to investigate whether growth stimulation is due to the surgical technique and whether joint distraction should be recommended during limb lengthening in growing children.

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The Use of External Fixators in Femur Fractures in Children

Cited by 44 publications

References 11 publications

External Fixation for Closed Pediatric Femoral Shaft Fractures: Where Are We Now?

External Fixation for Closed Pediatric Femoral Shaft Fractures: Where Are We Now?

Surgical treatment of femoral fractures in childrenComparison between external fixation and elastic intramedullary nails: A review

Growth rate after limb deformity correction by the Ilizarov method with or without knee joint distraction

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