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

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

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03856-4 ◽

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.

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

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.15.200252 ◽

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

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

10.21203/rs.3.rs-76990/v1 ◽

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.

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

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i10.2456 ◽

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.

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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)

10.2196/preprints.16905 ◽

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

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Analysis of Metal Failures for the femur Shaft Fractures

Journal of the Korean Fracture Society ◽

10.12671/jksf.1998.11.3.501 ◽

1998 ◽

Vol 11 (3) ◽

pp. 501

Author(s):

Kyung Jin Song ◽

Hwang Jik Kim ◽

Jeong Ryul Kim ◽

Joo Hong Lee ◽

Byung Yun Hwang

Keyword(s):

Shaft Fractures ◽

Femur Shaft ◽

Femur Shaft Fractures

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Butterfly Fragment in the Femoral Shaft Fractures Treated by Intramedullary Nail: Do We Need to Reduce It or Not?

10.21203/rs.3.rs-51108/v1 ◽

2020 ◽

Author(s):

Tayyar Kürşat Dabak ◽

Osman Ci̇van ◽

Hakan Özdemi̇r

Keyword(s):

Intramedullary Nail ◽

Fragment Size ◽

Femoral Shaft ◽

Shaft Fracture ◽

Variance Analysis ◽

Gap Size ◽

Femur Shaft Fracture ◽

Femoral Shaft Fractures ◽

Significant Difference ◽

Femur Shaft

Abstract Background: Limited data is available regarding the effect of gap size, fragment size and position of fragment on union in fragmented femur shaft fracture. The aim of the study is to analyze the effect of these parameters on union and determine cut-off values that necessitate reduction of fragment. Methods: Total of 59 patients with fragmented femur shaft fracture were reviewed and the effect of fragment size, gap size and fragment position on union were evaluated on 3rd, 6th and 12th month graphies from medical record of patients. Union rate was determined due to Radiographic Union Score of Femur. Patients were divided into small gap ( 10 mm) or large gap (10 mm), reverse fragment or non-reverse fragment and small fragment (50 mm) or large fragment (50mm) groups. Kruskal–Wallis Variance Analysis and Mann Whitney U test was used for comparisons among groups. The post-hoc Mann Whitney U-Test with Bonferroni Correction was used when the Kruskal Wallis Variance Analysis determined a significant difference.Results: In comparison of union scores of groups in regarding gap size and fragment size, there was not significant difference between groups at 3rd, 6th and 12th months. Union scores in the 3rd month (p=0,011) and 6th month (p=0,039) were lower in the reverse group than non-reverse group. But there was not statistically significant difference between two groups at 12th month (p=0.819). There was no significant difference in union rates in respect to intramedullary nail types. There was an indirect correlation between age and mean union score at 12th month. Conclusions: we could not determine any cutoff value regarding gap width and fragment size in the treatment of the femoral shaft fractures by IMN. Although there was a tendency to decrease in union scores due to the increase in the gap size, any significant difference was not determined. Only the reverse position of fragment had an adverse effect on the union until 6th months but the union score of reverse group reached the result of the non-reverse group by 12th months.

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