Treatment of Pediatric Diaphyseal Femur Fractures

Kocher, Mininder S.; Sink, Ernest L.; Blasier, R. Dale; Luhmann, Scott I.; Mehlman, Charles T.; Scher, David M.; Matheney, Travis; Sanders, James O.; Watters, William C.; Goldberg, Michael J.; Keith, Michael W.; Haralson, Robert H.; Turkelson, Charles M.; Wies, Janet L.; Sluka, Patrick; Hitchcock, Kristin

doi:10.5435/00124635-200911000-00006

Cited by 145 publications

(117 citation statements)

References 27 publications

Supporting

Mentioning

114

Contrasting

Unclassified

Order By: Relevance

“…The lower age limit for FIN has yet to be defined and most publications now refer to the onset of the school-aged period (5-6 years old) as the lower limit [10]. The AAOS 1 Clinical Practice Guideline for the treatment of paediatric diaphyseal femur fracture suggests early SCI or traction with delayed SCI in children aged 6 months to 5 years [11]. In today's Western society, children are going to kindergarten at a young age.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Immediate hip spica is as effective as, but more efficient than, flexible intramedullary nailing for femoral shaft fractures in pre-school children

Jauquier¹,

Doerfler

Haecker

et al. 2010

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

Flexible intramedullary nailing (FIN) is the gold standard treatment for femur fracture in school-aged children. It has been performed successfully in younger children, although Spica cast immobilisation (SCI) has been the most widely used strategy to date. Method A retrospective analysis was performed between two comparable groups of children aged 1-4 years with a femoral shaft fracture. Two University hospitals, each using specific treatment guidelines, participated in the study: SCI in Group I (Basel, Switzerland) and FIN in Group II (Lausanne, Switzerland). Results Group I included 19 children with a median age of 26 months (range 12-46 months). Median hospital stay was 1 day (range 0-5 days) and casts were retained for a median duration of 21 days (range 12-29 days). General anaesthesia was used in six children and sedation in four. Skin breakdown secondary to cast irritation occurred in two children (10.5%). The median follow-up was 114 months (range 37-171 months). No significant malunion was noted. Group II included 27 children with a median age of 38.4 months (range 18.7-46.7 months). Median hospital stay was 4 days (range 1-13 days). All children required general anaesthesia for insertion and removal of the nails.Free mobilisation and full weight bearing were allowed at a median of 2 days (range 1-10 days) and 7 days (range 1-30 days), respectively, postoperatively. Nail exteriorisation was noted in three children (11%). The median followup was 16.5 months (range 8-172 months). No significant malunion was reported. Conclusions Young children with a femoral shaft fracture treated by SCI or FIN had similarly favourable outcomes and complication rates. FIN allowed earlier mobilisation and full weight bearing. Compared to SCI, a greater number of children required general anaesthesia. In a pre-school child with a femoral shaft fracture, immediate SCI applied by a paediatric orthopaedic team following specific guidelines allowed early discharge from hospital with few complications.

show abstract

Section: Discussionmentioning

confidence: 99%

“…A prospective study between FIN and SCI including evaluation of total costs, post-immobilisation pain and socio-economic consequences is necessary to further refine current AAOS recommendations [11]. …”

Section: Discussionmentioning

confidence: 99%

Immediate hip spica is as effective as, but more efficient than, flexible intramedullary nailing for femoral shaft fractures in pre-school children

Jauquier¹,

Doerfler

Haecker

et al. 2010

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

show abstract

“…With internal fixation devices such as submuscular plates and intramedullary nails gaining popularity, external fixation is often not even mentioned as a treatment option as is the case in the recent American Academy of Orthopaedic Surgeons clinical practice guideline for treating pediatric diaphyseal femur fractures [15]. Given the recent advances in half pin designs and availability of various types of external fixators, we thought that external fixation might still have a role in the management of pediatric femoral shaft fractures.…”

Section: Discussionmentioning

confidence: 99%

“…With the advent of other forms of fixation, the use of external fixation has become less popular [11]. The recent American Academy of Orthopaedic Surgeons clinical practice guideline for treating pediatric diaphyseal femur fractures does not even mention external fixation as a treatment option [15].…”

Section: Introductionmentioning

confidence: 99%

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

Kong

Sabharwal

2014

Clin Orthop Relat Res

View full text Add to dashboard Cite

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.

show abstract

“…Furthermore, some treatment methods for diaphyseal fractures in children have seen a relatively rapid evolution of understanding, leaving the topic in somewhat continual flux. For example, while the 1990s saw the increasing use of elastic nails for operative stabilization of patients aged 5 to 12 years [1,[4][5][6][7], an increasing number of reports over the past two decades have highlighted technical challenges and complications, somewhat narrowing the indications for their use, while parallel evidence supporting submuscular plating has emerged [7][8][9][10][11][12][13][14][15][16]. Though complications associated with submuscular plating are also well-reported, including minor leg length discrepancies [11], plate fracture [11], re-fracture following plate removal [11], and fracture malalignment [15], the reports on this technique remain in their infancy and more long-term and higher-volume studies are needed before an exhaustive safety profile is understood.…”

Section: Introductionmentioning

confidence: 99%

Management of pediatric diaphyseal femur fractures

Heyworth

Suppan

Kramer

et al. 2012

Curr Rev Musculoskelet Med

View full text Add to dashboard Cite

A variety of strategies are utilized for management of pediatric diaphyseal femur fractures, depending chiefly on the age of the patient. Other factors that can influence the selection of a technique-which range from skeletal traction with spica casting to immediate spica casting, flexible intramedullary nailing, rigid intramedullary rodding, or plate fixation-are weight, fracture severity, associated injuries, and underlying medical or musculoskeletal conditions. The available evidence regarding technique, outcomes, and complications of the aforementioned treatment options remains largely insufficient, and, at times, conflicting, which contributes to the challenges in management decisions. Considerable controversy has arisen over several topics, particularly the optimal treatment for patients aged 5 to 12 years and accepted standards of treatment. This review is designed to provide perspective for some of the most recent influential literature on pediatric diaphyseal femur fracture treatment in light of established evidence and evolving controversies.

show abstract

Treatment of Pediatric Diaphyseal Femur Fractures

Cited by 145 publications

References 27 publications

Immediate hip spica is as effective as, but more efficient than, flexible intramedullary nailing for femoral shaft fractures in pre-school children

Immediate hip spica is as effective as, but more efficient than, flexible intramedullary nailing for femoral shaft fractures in pre-school children

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

Management of pediatric diaphyseal femur fractures

Contact Info

Product

Resources

About