scholarly journals Leg length discrepancy, overgrowth, and associated risk factors after a pediatric tibial shaft fracture

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Woo Young Choi ◽  
Moon Seok Park ◽  
Kyoung Min Lee ◽  
Kug Jin Choi ◽  
Hyon Soo Jung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Shaft Fracture ◽  
Leg Length Discrepancy ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Leg Length ◽  
Treatment Methods ◽  
Length Discrepancy ◽  
Associated Risk Factors ◽  
Tibial Shaft Fractures

Abstract Background This study was performed to investigate leg length discrepancy (LLD), overgrowth, and associated risk factors after pediatric tibial shaft fractures. Materials and methods This study included 103 patients younger than 14 years of age (mean age 7.1 years; 75 boys, 28 girls) with unilateral tibial shaft fracture and a minimum follow-up of 24 months. LLD was calculated as the difference between the lengths of the injured and uninjured limbs. Overgrowth was calculated by adding the fracture site shortening from the LLD. Risk factors were assessed in patients with LLD < 1 cm and ≥ 1 cm and overgrowth < 1 cm and ≥ 1 cm. Results Casting and titanium elastic nailing (TEN) were performed on 64 and 39 patients, respectively. The mean LLD and overgrowth were 5.6 and 6.4 mm, respectively. There were significant differences in sex (p = 0.018), age (p = 0.041), fibular involvement (p = 0.005), injury mechanism (p = 0.006), and treatment methods (p < 0.001) between patients with LLDs < 1 cm and ≥ 1 cm. There were significant differences in sex (p = 0.029), fibular involvement (p = 0.002), injury mechanism (p = 0.008), and treatment methods (p < 0.001) between patients with overgrowth < 1 cm and ≥ 1 cm. Sex and treatment methods were risk factors associated with LLD ≥ 1 cm and overgrowth ≥ 1 cm following pediatric tibial shaft fracture. The boys had a 7.4-fold higher risk of LLD ≥ 1 cm and 5.4-fold higher risk of overgrowth ≥ 1 cm than the girls. Patients who underwent TEN had a 4.3-fold higher risk of LLD ≥ 1 cm and 4.8-fold higher risk of overgrowth ≥ 1 cm than those treated by casting. Conclusions Patients undergoing TEN showed greater LLD and overgrowth than those undergoing casting, with boys showing greater LLD and overgrowth than girls. Surgeons should consider the possibility of LLD and overgrowth after pediatric tibial shaft fractures, especially when performing TEN for boys. Level of evidence Level III

scholarly journals Leg-length discrepancy and associated risk factors after paediatric femur shaft fracture: a multicentre study

2021 ◽  
pp. 1-8
Author(s):  
Tae Gyun Kim ◽  
Moon Seok Park ◽  
Sang Hyeong Lee ◽  
Kug Jin Choi ◽  
Byeong-eun Im ◽  
...  
Keyword(s):  
Risk Factors ◽  
Shaft Fracture ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Femur Shaft Fracture ◽  
Length Discrepancy ◽  
Associated Risk Factors ◽  
Femur Shaft ◽  
Fracture Stability ◽  
Femur Shaft Fractures

Purpose This study was performed to investigate leg-length discrepancy (LLD) and associated risk factors after paediatric femur shaft fractures. Methods A total of 72 consecutive patients under 13 years old (mean age 6.7 years; 48 boys, 24 girls) with unilateral femur shaft fracture, and a minimum follow-up of 18 months, were included. The amount of LLD was calculated by subtracting the length of the uninjured from that of the injured limb. Risk factors for an LLD ≥ 1 cm and ≥ 2 cm were analyzed using multivariable logistic regression analysis. Results Hip spica casting, titanium elastic nailing and plating were performed on 22, 40 and ten patients, respectively. The mean LLD was 7.8 mm (sd 8.8) and 29 (40.3%) had a LLD of ≥ 1 cm, while nine (12.5%) had a LLD of ≥ 2 cm. There were significant differences in fracture stability (p = 0.005) and treatment methods (p = 0.011) between patients with LLD < 1 cm and ≥ 1 cm. There were significant differences in fracture site shortening (p < 0.001) and LLD (p < 0.001) between patients with length-stable and length-unstable fractures. Fracture stability was the only factor associated with LLD ≥ 1 cm (odds ratio of 4.0; p = 0.020) in the multivariable analysis. Conclusion This study demonstrated that fracture stability was significantly associated with LLD after paediatric femur shaft fractures. Therefore, the surgeon should consider the possibility of LLD after length-stable femur shaft fracture in children. Level of Evidence Prognostic level III

Leg Length Discrepancy after Ender Nail Fixation in Children Femoral Shaft Fracture

2000 ◽  
Vol 13 (1) ◽  
pp. 172
Author(s):  
Jin Woo Kwon ◽  
Seung Ho Shin ◽  
Won Ho Cho ◽  
Woo Se Lee ◽  
Jin Ho Park
Keyword(s):  
Femoral Shaft Fracture ◽  
Femoral Shaft ◽  
Shaft Fracture ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Length Discrepancy

scholarly journals Radiographic cortical thickness parameters as predictors of rotational alignment in proximal tibial shaft fractures: a cadaveric study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alexander M. Keppler ◽  
Konstantin Küßner ◽  
Anna-Lena Schulze ◽  
Eduardo M. Suero ◽  
Carl Neuerburg ◽  
...  
Keyword(s):  
Cortical Thickness ◽  
Shaft Fracture ◽  
Diagnostic Tools ◽  
Transverse Diameter ◽  
Suitable Model ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Shaft Fractures ◽  
Torsional Malalignment ◽  
Tibial Shaft Fractures

Abstract Aim The treatment of tibial fractures with an intramedullary nail is an established procedure. However, torsional control remains challenging using intraoperatively diagnostic tools. Radiographic tools such as the Cortical Step Sign (CSS) and the Diameter Difference Sign (DDS) may serve as tools for diagnosing a relevant malrotation. The aim of this study was to investigate the effect of torsional malalignment on CSS and DDS parameters and to construct a prognostic model to detect malalignment. Methods A proximal tibial shaft fracture was set in human tibiae. Torsion was set stepwise from 0° to 30° in external and internal torsion. Images were obtained with a C-arm and transferred to a PC for measuring the medical cortical thickness (MCT), lateral cortical thickness (LCT), tibial diameter (TD) in AP and the anterior cortical thickness (ACT) as well as the posterior cortical thickness (PCT) and the transverse diameter (TD) of the proximal and the distal main fragment. Results There were significant differences between the various degrees of torsion for each of the absolute values of the examined variables. The parameters with the highest correlation were TD, LCT and ACT. A model combining ACT, LCT, PCT and TD lateral was most suitable model in identifying torsional malalignment. The best prediction of clinically relevant torsional malalignment, namely 15°, was obtained with the TD and the ACT. Conclusion This study shows that the CSS and DDS are useful tools for the intraoperative detection of torsional malalignment in proximal tibial shaft fractures and should be used to prevent maltorsion.

scholarly journals Impact of centre volume, surgeon volume, surgeon experience and geographic location on reoperation after intramedullary nailing of tibial shaft fractures

2021 ◽  
Vol 64 (4) ◽  
pp. E371-E376
Author(s):  
Marc Swiontkowski ◽  
David Teague ◽  
Sheila Sprague ◽  
Sofia Bzovsky ◽  
Diane Heels-Ansdell ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Intramedullary Nailing ◽  
Shaft Fracture ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Intramedullary Nails ◽  
Shaft Fractures ◽  
Fracture Management ◽  
Low Volume ◽  
Tibial Shaft Fractures

Background: Tibial shaft fractures are the most common long-bone injury, with a reported annual incidence of more than 75 000 in the United States. This study aimed to determine whether patients with tibial fractures managed with intramedullary nails experience a lower rate of reoperation if treated at higher-volume hospitals, or by higher-volume or more experienced surgeons. Methods: The Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) was a multicentre randomized clinical trial comparing reamed and nonreamed intramedullary nailing on rates of reoperation to promote fracture union, treat infection or preserve the limb in patients with open and closed fractures of the tibial shaft. Using data from SPRINT, we quantified centre and surgeon volumes into quintiles. We performed analyses adjusted for type of fracture (open v. closed), type of injury (isolated v. multitrauma), gender and age for the primary outcome of reoperation using multivariable logistic regression. Results: There were no significant differences in the odds of reoperation between high- and low-volume centres (p = 0.9). Overall, surgeon volume significantly affected the odds of reoperation (p = 0.03). The odds of reoperation among patients treated by moderate-volume surgeons were 50% less than those among patients treated by verylow-volume surgeons (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.28–0.88), and the odds of reoperation among patients treated by high-volume surgeons were 47% less than those among patients treated by very-low-volume surgeons (OR 0.53, 95% CI 0.30–0.93). Conclusion: There appears to be no significant additional patient benefit in treatment by a higher-volume centre for intramedullary fixation of tibial shaft fractures. Additional research on the effects of surgical and clinical site volume in tibial shaft fracture management is needed to confirm this finding. The odds of reoperation were higher in patients treated by very-low-volume surgeons; this finding may be used to optimize the results of tibial shaft fracture management. Clinical trial registration: ClinicalTrials.gov, NCT00038129

scholarly journals Outcome of Elastic Stable Intramedullary Nailing (ESIN) for tibia fractures in children.

2021 ◽  
Vol 28 (01) ◽  
pp. 16-21
Author(s):  
Kashif Khurshid Qureshi ◽  
Imran Anjum ◽  
Rao Tayyab Mehmood ◽  
Iram Habib ◽  
Ahmed Jasra ◽  
...  
Keyword(s):  
Case Series ◽  
Sampling Technique ◽  
Shaft Fracture ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Shaft Fractures ◽  
Fractures In Children ◽  
Case Series Study ◽  
Medullary Nailing ◽  
Tibial Shaft Fractures

Objectives: To determine outcome in displaced tibial shaft fracture in children treated with elastic stable intra-medullary nailing. Study Design: Descriptive, Case Series study. Setting: Department of Orthopedic, Bahawal Victoria Hospital, Bahawalpur, HBS Medical & Dental College, Islamabad and HITEC-IMS Taxila Cantt, Pakistan. Period: 2012 to 2019. Material & Methods: A total of 62 cases of displaced tibial shaft fracture presenting within 7 days of the injury, 6 to 11 years of age of either gender were included. Patients with segmental tibial shaft fractures and open tibial shaft fractures, Gustilo Grade II & III were excluded. The titanium elastic nails system (TENS) was used in all patients according to the departmental protocols. The sampling technique was consecutive with non-probability. All the patients were followed up in OPD at 2 weeks interval up to 24 weeks after surgery and union of fracture was recorded at 24th week. Results: Mean age was8.55 ± 1.77 years. Out of these 62 patients, 45 (72.58%) were male and 17 (27.42%) were females with ratio of 2.65:1. Mean duration of fracture was 3.10 ± 1.95 days. Mean duration of union in displaced tibial shaft fracture in children treated with elastic stable intra-medullary nailing was 19.40 ± 3.35 weeks. Conclusion: This study concluded that use of elastic stable intra-medullary nailing for displaced tibial shaft fracture in children leads to shorter duration of union reliably with minimal complications.

scholarly journals Risk factors for leg length discrepancy in patients with congenital vascular malformation

2006 ◽  
Vol 44 (3) ◽  
pp. 545-553 ◽  
Author(s):  
Young-Wook Kim ◽  
Sang-Hoon Lee ◽  
Dong-Ik Kim ◽  
Young-Soo Do ◽  
Byung-Boong Lee
Keyword(s):  
Risk Factors ◽  
Vascular Malformation ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Length Discrepancy ◽  
Congenital Vascular Malformation
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