Management of complex femur fractures in children: A report of Three Cases

2021 ◽  
Vol 11 (10) ◽  
Author(s):  
Shrihari L Kulkarni ◽  
Sunil Mannual ◽  
Manjunath Daragad ◽  
Naveenkumar Patil ◽  
Daniel Ernest
Keyword(s):  
Intertrochanteric Fracture ◽  
Dynamic Compression ◽  
Shaft Fracture ◽  
Femur Fractures ◽  
Titanium Elastic Nailing ◽  
Shaft Fractures ◽  
Fractures In Children ◽  
Operative Planning ◽  
Femur Shaft ◽  
Femur Shaft Fractures

Introduction:Complex femur fractures are defined as combined fractures of shaft and proximal of or the distal femur. Restoration of anatomical alignment is the primary goal of the management of these fractures. In this report, we describe the management of complex femur shaft fractures in three pediatric patients. Case Report: This report includes three patients. The first patient was a 10-year-boy with comminuted proximal femur shaft fracture extending into the subtrochanteric area, managed with minimally invasive sub-muscular plating. The second patient was a 12-year-boy with comminuted femur shaft extending into subtrochanteric area, treated with combined retrograde and anterograde Titanium Elastic Nail System. A 12-year-old boy with femur shaft with intertrochanteric fracture managed with K-wire fixation for intertrochanteric fracture and plating with dynamic compression plate for femur shaft was our third patient. All patients had excellent radiological and functional outcome. Conclusion: Complex femur shaft fractures in children are very rare and challenging injuries. With proper pre-operative planning and use of appropriate implants excellent outcomes can be obtained. Keywords:Complex femur fractures, pediatric orthopedics, sub-muscular plating, titanium elastic nailing.

A COMPARATIVE STUDY TO DETERMINE THE KNEE JOINT FUNCTIONAL OUTCOME IN PATIENTS WITH FEMUR SHAFT FRACTURES MANAGED OPERATIVELY OR CONSEVATELY AT NDOLA HOSPITAL:complete enumeration (Preprint)

2019 ◽  
Author(s):  
Ripedah Nakana
Keyword(s):  
Knee Joint ◽  
Functional Outcome ◽  
Road Traffic ◽  
Femur Fracture ◽  
Conservative Group ◽  
Femur Fractures ◽  
Shaft Fractures ◽  
Significant Difference ◽  
Femur Shaft ◽  
Femur Shaft Fractures

BACKGROUND According to WHO, It has been reported that there has been a rise in road traffic accidents globally due to many factors. Consequently this has contributed to an increase in fracture of the femur in hospitals. The annual incidence of these Fractures has been estimated to be 10 per 100,000 persons and this incidence has been noticed to be higher among the youths decreasing after the age of 40 and then increasing in the elderly. These fractures are either managed conservatively or operatively. OBJECTIVE the aim of this study was to determine if there is a significant difference in knee joint functional outcome in patients with femur shaft fractures managed operatively and conservatively at Ndola Teaching Hospital at the orthopedics clinic and physiotherapy. This in future might help to place emphasis on government to sensitize the right measures needed to improve on the functional outcome of a knee joint in patients with femur fracture who are treated operatively or conservatively METHODS the method used for the study was a complete enumeration of all patients with femur fractures that were admitted at orthopedic ward, visited the orthopedic clinic and physiotherapy sessions at NTH between the period of July 2019 to September 2019. Data collected will be analyzed using a statistical data software called Statistical Package of Social Sciences (SPSS). The independent variable that will be considered in the study are age, DOI, DOA, femur shaft fractures, treatment and others that that will meet the selection Criteria. The dependent variable will be “Knee Joint Functional Outcome”. RESULTS Results did not show statistically significant difference in knee functional outcome for two methods (conservative or operative). In the current study it was noted that there was much reduction in swelling in the operative in comparison to the conservative group. We may therefore conclude that the operative management promises a better outcome especially when done on time. However it seemed the operative procedure was not preferred for any conservative approach however the study has shown an in depth feasibility study to affirm such findings in order to inform on policy or management paradigim shift. CONCLUSIONS There is need for further intervention in the management of femur fracture which complicates to poor knee joint function

scholarly journals The epidemiology of infant shaft fractures of femur or humerus by incidence, birth, accidents, and other causes

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Johan von Heideken ◽  
Ingemar Thiblin ◽  
Ulf Högberg
Keyword(s):  
Gestational Age ◽  
Shaft Fracture ◽  
Bone Fragility ◽  
Shoulder Dystocia ◽  
Multiple Birth ◽  
Shaft Fractures ◽  
Humerus Shaft Fracture ◽  
Femur Shaft ◽  
Humerus Shaft ◽  
Femur Shaft Fractures

Abstract Background The purpose of this population-based registry study was to analyze both birth-related femur and humerus shaft fractures and diagnosed later in infancy, as regards incidence, perinatal characteristics, other diagnoses, and reported accidents. Methods Children born in 1997–2014, diagnosed with a femur or humerus shaft fracture before age 1 year, were identified in the Swedish Health Registries. Rate of birth fractures were estimated by combining femur and humerus shaft fractures coded as birth-related with femur and humerus shaft fractures diagnosed during day 1–7 without registered trauma or abuse. Incidence was computed by comparing infants with femur or humerus shaft fractures to the total at-risk population. Results The incidence for birth-related femur shaft fractures was 0.024 per 1000 children (n = 45) and that for birth-related humerus shaft fractures was 0.101 per 1000 children (n = 188). The incidence was 0.154 per 1000 children for later femur shaft fractures (n = 287) and 0.073 per 1000 children for later humerus shaft fractures (n = 142). Birth-related femur shaft fracture was associated with shoulder dystocia, cesarean, multiple birth, breech, preterm, and small-for-gestational age, while humerus shaft fracture was associated with maternal obesity, dystocic labor, shoulder dystocia, vacuum-assisted delivery, male sex, multiple birth, breech, preterm, large-for-gestational age, birth weight > 4000 g, and injury of brachial plexus. A bone fragility diagnosis was recorded in 5% of those with birth-related or later femur shaft fractures. Among infants with birth-related humerus shaft fractures, 1% had a bone fragility diagnosis; the figure for later fractures was 6%. Maltreatment diagnosis was associated with later fractures of both types, especially among those aged < 6 months, where approximately 20% (femur) and 14% (humerus) of cases, respectively, were associated with abuse. Fall accidents were reported in 73 and 56% among those with later femur and humerus shaft fractures, respectively. Conclusion This study provides data on epidemiology, birth, parental characteristics, and reported accidents in relation to femur and humerus shaft fractures during infancy. Few children had a bone fragility diagnosis. Fall accidents were the main contributor to femur or humerus shaft fracture during infancy; however, the proportion of fractures attributed to maltreatment was high in children under 6 months.

scholarly journals TITANIUM ELASTIC NAIL - COMPLICATIONS IN THE TREATMENT OF PAEDIATRIC DIAPHYSEAL FRACTURE OF FEMUR§

2013 ◽  
Vol 7 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Saikat Sarkar ◽  
Ranadeb Bandyopadhyay ◽  
Arindam Mukherjee
Keyword(s):  
Femoral Shaft ◽  
Shaft Fracture ◽  
Fracture Site ◽  
Diaphyseal Fracture ◽  
Entry Site ◽  
Superficial Infection ◽  
Femur Fractures ◽  
Titanium Elastic Nailing ◽  
Fractures In Children ◽  
Proximal Migration

Background: Femoral shaft fracture is the most common major paediatric orthopaedic. For generations traction and casting was the standard treatment for all femoral shaft fractures in children. Over the past two decades the advantages of fixation and rapid mobilisation have been increasingly recognised. Methods: A prospective study was conducted in five private hospitals in the district of Bankura, West Bengal over a period of two years (April 2010 to March 2012) on 70 patients with closed shaft femur fractures between 6- 14 years age of either sex. The aim was to find out the short term complications of titanium elastic nailing in diaphyseal fracture of femur in children and compare the findings of this study with pre- existing studies in this field. Results: In our study the most common complication was pain at nail entry site (60%). 5.71% had local inflammatory reaction due to nails. Superficial infection occurred in 2.85%. At the end of 1 year, 2.85% had limb length discripancies. Proximal migration occurred in 2.85%. 2.85% encountered acute reactive synovitis, 5.71% developed angulation of fracture site and 2.85% developed per operative breakage of nail. Conclusion: The treatment of paediatric shaft femur fracture has been drastically changed over the last two decades to internal fixation by elastically stable intra- medullary nail (ESIN). In our study, we encountered only a few complications most of them being minor. Most of the complications were surgical technique related and were seen at the initial phase of the learning curve.

scholarly journals The Epidemiology of Infant Shaft Fractures of Femur or Humerus by Incidence, Birth, Accidents, and Other Causes

2020 ◽  
Author(s):  
Johan von Heideken ◽  
Ingemar Thiblin ◽  
Ulf Högberg
Keyword(s):  
Shaft Fracture ◽  
Population Based ◽  
Bone Fragility ◽  
Multiple Birth ◽  
Shaft Fractures ◽  
Humerus Shaft Fracture ◽  
Femur Shaft ◽  
Humerus Shaft ◽  
Femur Shaft Fractures ◽  
Fall Accidents

Abstract Background: Knowledge of femur and humerus shaft fractures during infancy is scarce. The purpose of this population-based registry study was to analyze both birth-related femur and humerus shaft fractures and those diagnosed later in infancy, as regards incidence, perinatal characteristics, other diagnoses, and reported accidents.Methods: Children born in 1997–2014, diagnosed with a femur or humerus shaft fracture before age 1 year, were identified in the Swedish Health Registries. Rate of birth fractures were estimated by combining femur and humerus shaft fractures coded as birth-related with femur and humerus shaft fractures diagnosed during day 1-7 without registered trauma, abuse, or bone fragility disorders. Incidence was computed by comparing infants with femur or humerus shaft fractures to the total at-risk population. Results: The incidence for birth-related femur shaft fractures was 0.024‰ (n=45) and that for birth-related humerus shaft fractures was 0.101‰ (n=188). The incidence was 0.154‰ for later femur shaft fractures (n=287) and 0.073‰ for later humerus shaft fractures (n=142). Birth-related femur shaft fracture was associated with preterm, multiple birth, breech, cesarean, and small-for-gestational age, while humerus shaft fracture was associated with preterm, multiple birth, birth weight > 4,000 g, and shoulder dystocia. A bone fragility diagnosis was recorded in 5% of those with birth-related or later femur shaft fractures. Among infants with birth-related humerus shaft fractures, 1% had a bone fragility diagnosis; the figure for later fractures was 6%. Maltreatment diagnosis was associated with both fracture types, especially among those aged < 6 months, where approximately 20% and 14% of cases, respectively, were associated with abuse. Fall accidents were reported in 73% and 56% among those with later femur and humerus shaft fractures, respectively. Conclusion: This study provides data on epidemiology, birth, parental characteristics, and reported accidents in relation to femur and humerus shaft fractures during infancy. Few children had a bone fragility diagnosis. Fall accidents were the main contributor to femur or humerus shaft fracture during infancy; however, the proportion of fractures attributed to maltreatment was high in children under 6 months.

scholarly journals Elastic Stable Titanium Flexible Intramedullary Nails Versus Plates in Treating Low Grade Comminuted Femur Shaft Fractures in Children

2019 ◽  
Vol 11 (4) ◽  
pp. 664-670
Author(s):  
Yi Luo ◽  
Lin Wang ◽  
Li‐hua Zhao ◽  
Yi‐cheng Wang ◽  
Meng‐jie Chen ◽  
...  
Keyword(s):  
Low Grade ◽  
Intramedullary Nails ◽  
Shaft Fractures ◽  
Fractures In Children ◽  
Flexible Intramedullary Nails ◽  
Femur Shaft ◽  
Femur Shaft Fractures

Outcome of Titanium Elastic Nailing in the Surgical Management of Femoral-Shaft Fracture in Children

2020 ◽  
Vol 2 (2) ◽  
pp. 61-66
Author(s):  
Rajram Maharjan ◽  
Rishi Bisht ◽  
Dipesh Pariyar
Keyword(s):  
Femoral Shaft Fracture ◽  
Insertion Site ◽  
Operating Time ◽  
Femoral Shaft ◽  
Shaft Fracture ◽  
Age Group ◽  
Femoral Shaft Fractures ◽  
Titanium Elastic Nailing ◽  
Shaft Fractures ◽  
Fractures In Children

Introduction: Femoral shaft fracture is one of the most common orthopedic injuries of the children. These fractures treated non-operatively by traction followed by hip spica require prolonged hospitalization causing undue physical and psychological stress for patient and patient family. Loss of reduction is also commonly seen with hip spica that leads to unacceptable complications like angular deformities and limb length discrepancies. Titanium Elastic Nailing (TEN) is becoming widely accepted treatment for femoral shaft fractures in children due to its simplicity and physeal protective stable load sharing construct that allows early mobilization. The purpose of this study was to see the outcome of operative treatment of femoral shaft fracture in children by TEN. Methods: A retrospective observational study was carried out in the Department of Orthopedics in National Academy of Medical Sciences, National Trauma Center from February 2017 to January 2019. Study was undertaken in 22 children between the age group of 5-14 years with femoral shaft fractures. Fixation with TEN was done for all fractures within nine days of injury. Patients were assessed radiologically as well as clinically until fractures healed. The results were evaluated using Flynn scoring criteria. Results: Radiological union was seen in all cases between 6–12 weeks after surgery. The mean operating time was 58 (48-115) minute and mean hospital stay after surgery was 9 (6-15) days. Results were excellent in 14 patients (63.63%), satisfactory in 6 patients (27.37%) & poor in 2 patients (9%). Six patients had skin irritation at nail insertion site which resolved after removal of nails. Functional range of motion in both hip and knee joints of affected limb was preserved in all cases after the removal of nails. Conclusion: TEN is an effective and safe treatment of femoral shaft fractures in children of 5-14 years of age group.  

scholarly journals Sociodemographic factors influence the risk for femur shaft fractures in children: a Swedish case-control study, 1997-2005

2013 ◽  
Vol 102 (4) ◽  
pp. 431-437 ◽  
Author(s):  
Johan von Heideken ◽  
Tobias Svensson ◽  
Maura Iversen ◽  
Paul Blomqvist ◽  
Yvonne Haglund-Åkerlind ◽  
...  
Keyword(s):  
Case Control Study ◽  
Sociodemographic Factors ◽  
Case Control ◽  
Shaft Fractures ◽  
Fractures In Children ◽  
Femur Shaft ◽  
Control Study ◽  
Femur Shaft Fractures

scholarly journals A five year learning experience with sequence of events in a child with closed femur shaft fracture

2021 ◽  
Vol 7 (3) ◽  
pp. 686
Author(s):  
Shrihari L. Kulkarni ◽  
Sunil Mannual ◽  
Manjunath Daragad ◽  
Naveenkumar Patil ◽  
Prateek M. Sharan
Keyword(s):  
Learning Experience ◽  
Shaft Fracture ◽  
Fracture Pattern ◽  
Definitive Treatment ◽  
Basic Principles ◽  
Femur Shaft Fracture ◽  
Sequence Of Events ◽  
Shaft Fractures ◽  
Femur Shaft ◽  
Femur Shaft Fractures

<p class="abstract">Femur shaft fractures are the most common fractures requiring hospitalization in children. Management of these fractures mainly depend on the age of the child. Associated injuries, fracture pattern, weight of the child and overlying soft tissue condition also influence the management. Still, the definitive treatment remains controversial in children between 5-16 years. We present our experience in management of 5 year old boy with mid shaft femur fracture and its complications. In his paper we want to highlight the importance of sticking to the basic principles and the recommendations in the management of the paediatric femur shaft fractures.</p>

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