Treatments for paediatric femoral fractures: a randomised trial

Wright, James G.; Wang, Elaine E. L.; Owen, Janice; Stephens, Derek; Graham, H. Kerr; Hanlon, Michelle; Nattrass, Gary; Reynolds, Rick A K; Coyte, Peter C.

doi:10.1016/s0140-6736(05)71878-x

Cited by 94 publications

(59 citation statements)

References 44 publications

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“…Prospective trials comparing different treatments for pediatric femoral fractures have typically been limited to younger children 11,12 , and the optimal management of femoral fractures in adolescents cannot be extrapolated from those studies. In this large retrospective cohort study, we compared the results and complications associated with four different methods of operative fixation by adjusting for baseline differences in patient, injury, and fracture characteristics that very likely played a role in treatment selection.…”

Section: Discussionmentioning

confidence: 99%

Femoral Fractures in Adolescents: A Comparison of Four Methods of Fixation

Ramseier

Janicki

Weir

et al. 2010

The Journal of Bone and Joint Surgery-American Volume

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Section: Discussionmentioning

confidence: 99%

Femoral Fractures in Adolescents: A Comparison of Four Methods of Fixation

Ramseier

Janicki

Weir

et al. 2010

The Journal of Bone and Joint Surgery-American Volume

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“…Treatment is typically based on the patient's age and the fracture pattern with treatment options including spica casting, flexible and rigid intramedullary nailing, submuscular plating, and external fixation [2,16]. Over time, operative treatment of pediatric femoral shaft fractures has gained popularity over nonoperative treatment because it shortens hospitalizations and allows earlier mobilization [27].…”

Section: Introductionmentioning

confidence: 99%

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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“…Spica cast has remained the standard for the treatment of children less than 5 years of age [14][15][16][17][18][19] , whereas older children are now more commonly treated with surgical intervention [20,21] . Multiple fixation modalities are available for the treatment of femoral shaft fractures, but the choice of the optimal fixation device is an area of ongoing controversy, especially in a 5-12 year old child.…”

Section: Discussionmentioning

confidence: 99%