Treatment of closed femoral shaft fractures in children aged 2–10 years: a systematic review and meta-analysis

Abstract Objective To review current literature on treatment of closed femoral shaft fractures in children of 2–10 years old, with subgroup analysis of children aged 2–6 years, comparing intramedullary nailing (IMN) to conservative treatment modalities. Methods We included clinical trials and observational studies that compared traction and subsequent casting (TSC), spica casting and IMN for treatment of femur shaft fractures in children of 2–10 years of age. Subgroup analysis of children aged 2–6 years was performed. Results Compared to treatment with immediate spica casting, IMN led to significantly less coronal angulation (mean difference (MD): 2.03 degrees, confidence interval (CI) 1.15–2.90), less sagittal angulation (MD: 1.59 degrees, CI 0.82–2.35) and lower rates of LLD (Risk difference (RD): 0.07, CI 0.03–0.11). In terms of rehabilitation, IMN leaded to shorter time until walking with aids (MD: 31.53 days, CI 16.02–47.03), shorter time until independent ambulation (MD: 26.59 days, CI 22.07, 31.11) and shorter time until full weight bearing (MD: 27.05 days, CI 6.11, 47,99). Compared to TSC, IMN led to a lower rate of malunion (RD: 0.31, CI 0.05–0.56), shorter hospital stays (MD: 12.48 days, CI 11.57, 13.39), time until walking with aids (MD: 54.55, CI 40.05–69.04) and full weight bearing (MD: 27.05 days [6.11, 47,99]). Conclusion Although a lack of quality evidence, this systematic review showed a clear tendency to treatment with elastic intramedullary nails of femoral shaft fractures in children of 2–10 years of age. Level of evidence 3.

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TENS for the surgical management of femoral shaft fractures in 6-14 years age group children

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors5213-21 ◽

2017 ◽

Vol 5 (2) ◽

pp. 13-21

Author(s):

Mohit Khanna ◽

Jitendra Wadhwani ◽

Amit Batra ◽

Sidharth Yadav ◽

Sarfraz Iman ◽

...

Keyword(s):

Prospective Study ◽

Weight Bearing ◽

Femoral Shaft ◽

Full Weight Bearing ◽

External Fixators ◽

Age Group ◽

Femoral Shaft Fractures ◽

Femur Fractures ◽

Shaft Fractures ◽

Fractures In Children

Background. Fracture shaft of femur in pediatric age group is one of the most common leading emergencies. Children in the age group of 6-14 years are treated with either traction, hip spica, flexible/elastic stable retrograde intramedullary nail, or external fixators. We conducted a clinical prospective study on the use of Titanium Elastic Nailing System (TENS) for the treatment of femoral shaft fractures in children. Methods. The prospective study included 45 cases of fresh femoral shaft fractures. The Inclusion Criteria were a) Age group of 6-14 years, b) Recent fracture of femur shaft c) Transverse, short oblique, minimally comminuted fractures. Results. The clinical results were evaluated using Flynn’s criteria of scoring as, Excellent in 40 patients (88.89 %), Satisfactory in 5 patients (11.12 %) and poor in none. Radiological criteria for fracture union were assessed by using Anthony et al scale. Nine patients developed bursitis at entry point of the nail. Three patients had superficial infection due to bursitis. Full weight bearing was possible in mean time of 8.7 weeks (range; 7-12 weeks). Conclusion. TENS is very effective in management of paediatric shaft femur fractures in the age group of 6-14 years with advantages of early union, early mobilization and manageable complications.

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Four Weeks in a Single-Leg Weight-Bearing Hip Spica Cast is Sufficient Treatment for Isolated Femoral Shaft Fractures in Children Aged 1 to 3 Years

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000000523 ◽

2016 ◽

Vol 36 (7) ◽

pp. 680-684 ◽

Cited By ~ 7

Author(s):

Sami Jaafar ◽

Ali Sobh ◽

Julie E. Legakis ◽

Ronald Thomas ◽

Kelsey Buhler ◽

...

Keyword(s):

Weight Bearing ◽

Femoral Shaft ◽

Spica Cast ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Fractures In Children ◽

Hip Spica Cast

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Management of compound fractures of shaft femur: a study of 55 cases

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164160 ◽

2016 ◽

Vol 2 (4) ◽

pp. 313

Author(s):

Gaurav Singla ◽

Amita Aggarwal ◽

Ravinder Singh

Keyword(s):

Femoral Shaft Fracture ◽

Weight Bearing ◽

Femoral Shaft ◽

Shaft Fracture ◽

Deep Infection ◽

Full Weight Bearing ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Mean Time

Background: Compound femoral shaft fractures are a major cause of morbidity and mortality. Conservative treatment necessitates a long stay in hospital for traction and subsequent immobilization and chances of wound infection are much higher. The objective of this study was to find out the outcome of treatment of open femoral shaft fractures by various modalities like interlocked nailing, plating and external fixation.Methods: Fifty five patients with open femoral shaft fractures were treated under spinal or general anaesthesia. These fractures were in proximal one third (n=3), middle third (n=29), distal third (n=21). Fifty patients underwent surgery within 5 days of injury. Patients were followed for a minimum of 12 Months.Results: Patients achieved union in an average time of 20 weeks (range 17 to 24 weeks). Full weight bearing was started in a mean time of 16 weeks. Mean duration of hospital stay was 20 days. Complications were occurred in ten patients (4 non-unions and 3 patients with deep infection and 3 patients developed chronic osteomyelitis). Conclusions: The results were excellent in 31, good in 13, fair in 3 and poor in 7 patients while one patient lost follow up as he was from far off place. We concluded that open femoral shaft fracture can be well managed by surgical intervention.

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A study on role of intramedullary interlocking nailing in the complex femoral shaft fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193585 ◽

2019 ◽

Vol 5 (5) ◽

pp. 843

Author(s):

Veera Kumaran ◽

Sachidhanandham .

Keyword(s):

Weight Bearing ◽

Femoral Fractures ◽

Femoral Shaft ◽

High Energy ◽

Rotational Stability ◽

Full Weight Bearing ◽

Care Hospital ◽

Femoral Shaft Fractures ◽

Interlocking Nailing ◽

Shaft Fractures

Background: Fractures of the shaft of the femur are a major cause of morbidity and mortality in patients who sustain high energy trauma. Morbidity arises from limb shortening, malalignment, knee contractures and other complications of fracture.Methods: The aim of our study is to analyze the results of complex femoral shaft fractures treated by intramedullary interlocking nailing in our institution. Totally 20 cases of complex femoral fractures from 2007-2009 were treated with intramedullary interlocking at Krishanakumar Orthopedic Care Hospital, Nagercoil were included in our study.Results: We found that fracture of femur is most common in 2nd, 3rd and 4th decade of life, with mean age of 35.85 years. Vehicular accident in 17 patients was observed to be the main cause of fracture in our series (85%). 4 patients started full weight bearing at 10th week, 9 patients were able to bear full weight at 12th week, 4 patients at 14th week and 2 at 16th week. Average time of full weight bearing was 12.4 weeks. One patient developed deep infection (osteomyelitis) at 12 weeks and later non union was seen and unable to bear full weight.Conclusions: Intramedullary interlocking nailing for complex femoral fractures has been established worldwide as the gold standard treatment because of its load sharing property, internal splinting, and rotational stability. These contribute the stable osteosynthesis.

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Traction and Spica Casting for Closed Femoral Shaft Fractures in Children

Journal of Orthopaedic Surgery ◽

10.1177/230949900701500109 ◽

2007 ◽

Vol 15 (1) ◽

pp. 37-40 ◽

Cited By ~ 12

Author(s):

YHD Lee ◽

KBL Lim ◽

GX Gao ◽

A Mahadev ◽

KS Lam ◽

...

Keyword(s):

Femoral Shaft ◽

Femoral Shaft Fractures ◽

Spica Casting ◽

Shaft Fractures ◽

Fractures In Children

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Diaphyseal Femoral Fractures in Children: Comparison Between Elastic Stable Intramedullary Nailing and Conservative Management

The Open Orthopaedics Journal ◽

10.2174/1874325001812010435 ◽

2018 ◽

Vol 12 (1) ◽

pp. 435-444

Author(s):

Las J. Hwaizi ◽

Areewan MS. Saeed ◽

Mustafa N. Mahmood

Keyword(s):

Conservative Management ◽

Weight Bearing ◽

Femoral Fractures ◽

Femoral Shaft ◽

Elastic Stable Intramedullary Nailing ◽

Return To School ◽

Femoral Shaft Fractures ◽

Spica Casting ◽

Fractures In Children ◽

Independent Ambulation

Background:Femoral shaft fractures are one of the most common fractures of the lower extremities in children. Although many approaches and options are available for their treatment, the most appropriate treatment option for school going children is still debatable.Objective:This study investigated the efficacy, safety, and outcome of surgical intervention with Elastic Stable Intramedullary Nailing (ESIN) in 3–12-year-old children with diaphyseal femoral fractures and compared them with those of conservative management.Methods:In this prospective study, 41 children with diaphyseal femoral fractures were recruited between April 2013 and April 2016. The fractures were divided into two equal groups: one treated with ESIN, and the other with early spica casting or noninvasive traction followed by hip spica casting. Demographic data, clinical information, and serial radiographic findings were collected and compared between the two groups. Flynn’s scoring criteria pertaining to time to union, assisted weight bearing, independent ambulation, return to school, and complications were applied. Fischer’s exact test was used for statistical analyses.Results:Compared with spica casting-treated fractures, ESIN-treated fractures healed faster with lower average time to assisted weight bearing, independent ambulation, and return to school. Hip spica-treated children had a higher rate of major complications than ESIN-treated children. At 1-year follow-up, higher limb length discrepancy was reported in hip spica-treated children than in ESIN-treated children (P< 0.001).Conclusion:ESIN is a safe and effective approach for treating femoral shaft fractures in children; it provides better functional and radiographic outcomes than spica casting and can be used in preschool-age children.

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Flexible Intramedullary Nailing of Femoral Shaft Fractures in Children Weighing ≥40 kg: A Systematic Review and Meta-analysis

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000001574 ◽

2020 ◽

Vol 40 (10) ◽

pp. 562-568

Author(s):

Christopher A. Makarewich ◽

Divya Talwar ◽

Keith D. Baldwin ◽

Ishaan Swarup

Keyword(s):

Systematic Review ◽

Intramedullary Nailing ◽

Meta Analysis ◽

Femoral Shaft ◽

Femoral Shaft Fractures ◽

Flexible Intramedullary Nailing ◽

Shaft Fractures ◽

Fractures In Children

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Close Versus Limited Open Method of Ender’s Nail Fixation in Paediatric Femoral Shaft Fractures

Journal of Nepal Medical Association ◽

10.31729/jnma.2756 ◽

1970 ◽

Vol 52 (194) ◽

pp. 806-810

Author(s):

Rajeev Dwivedi ◽

Shambu Sah ◽

Mukund Dahal ◽

Parimal Acharya ◽

Sandeep Gurung

Keyword(s):

Operative Time ◽

Weight Bearing ◽

Femoral Shaft ◽

Open Group ◽

Open Technique ◽

Femoral Shaft Fractures ◽

Open Method ◽

Shaft Fractures ◽

Fractures In Children ◽

Significant Difference

Introduction: There are various surgical options for treating fracture of femoral shaft in children. Here we compare the results of close with limited open method of Ender’s nails fixation of femoral shaft fractures in children. Methods: We studied 60 children with femoral shaft fractures in age group 5-15 years. Ender’s nail fixation was done by close technique in 40 cases and in 20 cases by limited open technique. Results: The mean operative time was significantly high in limited open group being 64 minutes in comparison to 50 minutes in close group. There was no significant difference between close and limited open groups with respect to time for partial weight bearing and time for full weight bearing. Fracture united sooner in close group as compared to open group. Union was achieved in all patients within a mean of 11 weeks in close group in comparison to 12.4 weeks in open group. According to the Flynn criteria in close group 34 patients had excellent results, 6 had satisfactory and none poor. In limited open group outcome was excellent in 14 patients, satisfactory in 4 patients and 2 had poor result. There was no significant difference in outcome based on Flynn criteria between two groups. Conclusions: Though operative time is more and healing is delayed in Ender’s nail fixation by limited open technique, there is no statistical difference in final outcome as per Flynn criteria between close and limited open technique of Ender’s nail fixation of femoral shaft fractures in children. Keywords: children; close technique; ender’s nail; fracture shaft of femur; flynn criteria.

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