Indications and methods for internal fixation of femoral fractures in children

Background: Subtrochanteric fractures in children are treated by different conservative and operative methods. Patient’s age may be the single most important factor deciding treatment. Several studies have documented superior results with internal fixation compared to non-operative treatment. The aim of the study is to evaluate the outcome of proximal humerus locking plate fixation of subtrochanteric femoral fractures in children.Methods: Between October 2015 and December 2017, 13 children with closed subtrochanteric femoral fractures including 3 pathological fractures were treated in our tertiary care teaching institute and the results were retrospectively analysed. Children of both sexes within 5–12½ years of age with isolated subtrochanteric fractures were included. There was no open fracture and fracture associated with neuromuscular disease or any systemic injury. In all cases, ORIF with proximal humerus locking plate was done using lateral approach.Results: Average age at the time of injury was 9.35 years (range 5–12 ½ years). There were four (30.77%) short oblique, four (30.77%) long oblique, three (23.08%) transverse fractures and two (15.38%) comminuted fractures. Average operative time was 88.76 minutes and average intra operative blood loss was 86.23 ml. Average follow-up was 13 months. All fractures showed radiological union at an average of 8 weeks. One case had superficial infection which was controlled by antibiotics. Two patients had limb lengthening (average 0.75 cm) but required no intervention.Conclusions: Internal fixation with adult proximal humerus locking plate appears as a good treatment option for paediatric subtrochanteric femoral fractures.

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Compensatory Tibial Overgrowth Following Healing of Closed Femoral Fractures in Young Dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632448 ◽

1995 ◽

Vol 08 (03) ◽

pp. 159-162 ◽

Cited By ~ 7

Author(s):

L. Susan ◽

R. T. O’Brien ◽

K. A. Johnson

Keyword(s):

Internal Fixation ◽

Femoral Fractures ◽

Surgical Reduction ◽

Femoral Shortening ◽

Hindlimb Lameness ◽

Femoral Condyles

SummaryTwo young dogs examined for hindlimb lameness were found to have healed femoral fractures, 2-4 cm of femoral shortening, and 1 cm of compensatory ipsilateral tibial overgrowth. Neither dog had had surgery or internal fixation. Although tibial overgrowth partially corrected for limb shortening, both dogs had chronic intermittent lameness due to malformation of the femoral condyles and secondary stifle osteoarthritis.Compensatory tibial overgrowth was found in two young dogs with femoral fractures which had healed without any surgical reduction or internal fixation. Tibial overgrowth of approximately 1 cm in each case partially compensated for 2-4 cm of femoral shortening.

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Validating scoring systems for fracture healing in infants and young children: pilot study

Pediatric Radiology ◽

10.1007/s00247-021-05038-3 ◽

2021 ◽

Author(s):

Samuel Crompton ◽

Fabrizio Messina ◽

Gillian Klafkowski ◽

Christine Hall ◽

Amaka C. Offiah

Keyword(s):

Pilot Study ◽

Young Children ◽

Fracture Healing ◽

Callus Formation ◽

Femoral Fractures ◽

Scoring Systems ◽

Power Calculation ◽

Small Pilot Study ◽

Fractures In Children ◽

Infants And Young Children

Abstract Background Recent studies have analysed birth-related clavicular fractures to propose time frames for healing that could be applied to dating of all fractures in cases of suspected child abuse. Objective To assess differences in healing rates between femoral fractures and birth-related clavicular fractures in infants and young children. Materials and methods A retrospective 5-year pilot study of femoral fractures in children younger than 3 years of age was performed. Anonymised radiographs were independently scored by two radiologists for stages of fracture healing. In cases of reader disagreement, radiographs were independently scored by a third radiologist. Results In total, 74 radiographs (30 children) met the inclusion criteria. Fracture healing evolved over time with subperiosteal new bone formation (SPNBF) appearing first, followed by callus then remodelling. A power calculation for a single proportion, with a level of confidence of 95% and a margin of error of 5%, showed that in a definitive study, 359 radiographs would be required. Conclusion Although the overall pattern of healing is similar, in this small pilot study, the earliest times for SPNBF and callus formation in femoral fractures appeared to lag behind healing of birth-related clavicular fractures. Remodelling appeared earlier than remodelling of clavicular fractures. A power calculation has determined numbers of femoral radiographs (359) required for a definitive study.

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