A review of pediatric femoral fracture patterns, surgical managements, and outcomes

Background: Femoral fractures are the most common pediatric orthopedic fractures that require hospitalization. The non-accidental injury should be suspected in early infancy and non-ambulatory children. Treatment of pediatric femoral fractures is widely variable and depends on intrinsic and extrinsic factors. This study presents pediatric femoral fracture epidemiology and outcomes and reviews the literature regarding best practices in pediatric femoral fractures.Methods: This retrospective study reviewed the clinical and radiological records of forty-sevens femur fractures in the pediatric age group from September 2020 until June 2021 in Prince Rashid bin AL Hassan Military Hospital in Jordan.Results: Males form 80.9% of patients. The mean age for the patients was equal to 6.70 years (±3.91). Falling is responsible for the majority of the injury. The middle femur shaft was fractured in 46.8%, and the pathological fracture was found in 17% of patients. Non-operative treatment by cast represents 42.6%. All fractures were healed at 7.90 weeks (±2.37).Conclusions: Pediatric femur fracture lacks standardized treatment. Nevertheless, most fractures healed with satisfactory results. Younger age groups are more likely to be treated non-operatively. Non-surgical treatment is more prone to shortening, angulation, and later return to weight-bearing and activity. Children older than eight years treated by plating demonstrated faster healing, return to full weight-bearing, and lower complication rate.

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A comparative study of surgical management of subtrochanteric fractures in children

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v11i2.9664 ◽

2012 ◽

Vol 11 (2) ◽

pp. 91-97

Author(s):

Ramji Lal Sahu ◽

Pratiksha Gupta

Keyword(s):

Femoral Fracture ◽

Weight Bearing ◽

Medical Science ◽

Femoral Fractures ◽

Long Bone ◽

Full Weight Bearing ◽

Entry Site ◽

Early Weight Bearing ◽

Fractures In Children ◽

Mean Time

Introduction: Subtrochateric femoral fracture is a major cause of morbidity and mortality in patients with lower extremity injuries. There have been no studies that have specifically looked at the management of subtrochanteric femoral fractures in skeletally immature adolescents. It was the purpose of this study to investigate the treatment of this injury in this unique patient population. Methods: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2008. Thirty-four patients were recruited from Emergency and out patient department having closed subtrochanteric femoral fracture. All patients were operated under general or spinal anesthesia. All patients were followed for twelve months. Results: All children achieved union in a mean time of 10 weeks (range from 6 - 16 weeks) depending on the type of long bone. Full weight bearing was possible in a mean time of 8.8 weeks. Mean duration of hospital stay was 9.8 days. The mean follow-up period was 28 months (17-48 months). Complications were recorded in 4 (11.77%) patients and included: two entry site skin irritations, one protrusion of the wires through the skin and one delayed union. The results were excellent in 97.06% and good in 2.97% patients. Conclusions: We conclude that Rigid and close interlocking nailing between the age of 9-16 years offered excellent fracture stability allowing early mobilization (early weight bearing) and joint motion in comparisons to the other groups and between the age of 6-8 years titanium elastic nail and bridging plate offered excellent result.DOI: http://dx.doi.org/10.3329/bjms.v11i2.9664 Bangladesh Journal of Medical Science Vol. 11 No. 02 April 2012: 91-97

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Radiologic and functional outcome in patients with ipsilateral fractures of proximal femur and shaft treated by long proximal femoral nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20205574 ◽

2020 ◽

Vol 7 (1) ◽

pp. 129

Author(s):

Saju S. ◽

Thomas M. A.

Keyword(s):

Functional Outcome ◽

Proximal Femur ◽

Weight Bearing ◽

Femoral Fractures ◽

Full Weight Bearing ◽

Femoral Nailing ◽

Femur Fractures ◽

The Mean ◽

Mean Time ◽

Proximal Femoral Nailing

Background: Combination of ipsilateral proximal femur and shaft of femur fractures are one of the rare fractures which were previously managed with two different implants for each fracture. Various studies have shown that long proximal femoral nailing is as effective as two different implants in fracture healing.Methods: 25 cases in the age group of 20-80 years with ipsilateral proximal femur and shaft of femur fractures were enrolled from July 2014 to July 2017 and treated with long proximal femoral nailing. The cases were followed up at 6 weekly intervals and were assessed for their functional outcome using Friedman and Wyman criteria.Results: Proximal femoral fractures united at an average time of 3.96 ±1.3 months, whereas the mean time shaft of femur fractures took to unite was 5.67±3 months. The mean time patients took to start full weight bearing was 6.15±2.76 months. Functional assessment at 12 months revealed outcome as good in18 (75%), fair in 5 (20.8%) and poor in 1 (4.1%).Conclusions: Long proximal femoral nailing is a good option in managing patients with ipsilateral proximal and shaft of femur fractures.

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Internal fixation of pediatric shaft femur fractures by titanium elastic nails: clinical and radiological study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164157 ◽

2016 ◽

Vol 2 (4) ◽

pp. 299

Author(s):

Manoharan M. ◽

Mahapatra S.

Keyword(s):

Weight Bearing ◽

Joint Stiffness ◽

Femoral Fractures ◽

Full Weight Bearing ◽

Age Group ◽

Femur Fractures ◽

Pediatric Age Group ◽

Elastic Nails ◽

Elastic Nail ◽

Operative Fixation

Background: Management of diaphyseal femoral fractures in the pediatric age group is challenging. There has been a demand worldwide for operative fixation.Methods: Twelve children (7 boys, five girls) aged 6-16 years with diaphyseal femoral fractures (12 fractures, one in each) was stabilized with titanium elastic nail system (TENS). Patients underwent surgery within a week days of their injury. The results were evaluated using Flynn's Scoring system. Identical two nails were used in each fracture.Results: All 12 patients were available for evaluation and follow-up for a mean duration of 24 months (14-34 months). Radiological union in all cases was seen at a mean duration of 8 weeks. Full weight bearing was possible at a mean duration of 10 weeks (8-12 weeks). The results were excellent in 8 patients (67%) and satisfactory in 4 patients (33%). Complications that occurred were infection (2 cases), knee joint stiffness (4 cases), angulation <10 degrees (1 case), and shortening less than 10 mm (2 cases). Conclusions: Intramedullary fixation by TENS is an effective, time-tested treatment of fracture of the femur in patients of the 6-16 years age group.

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Locking condylar plate: best device to treat supracondylar fractures of the femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190966 ◽

2019 ◽

Vol 5 (3) ◽

pp. 393

Author(s):

Irwant V. Pallewad ◽

Vijay B. Kagne ◽

Jayshree J. Upadhye

Keyword(s):

Fracture Fixation ◽

Distal Femur ◽

Road Traffic ◽

Weight Bearing ◽

Femoral Fractures ◽

Research Centre ◽

Full Weight Bearing ◽

Supracondylar Fractures ◽

Femur Fractures ◽

Fractures Of The Femur

Background: Supracondylar fractures of the femur in adults account for only 7% of all femoral fractures. However, these fractures present with numerous complications. The purpose of this study was to assess the outcome of locking condylar plate in supracondylar fractures of femur in adults.Methods: This study was based on 25 patients of supracondylar fracture of the femur treated with locking condylar plate at Srinivas Institute of Medical Sciences and Research Centre, Mukka, Suratkal, Mangalore. The patients were followed up for 1 year.Results: In present study, 84% fractures were sustained due to road traffic accidents. In 23 (92%) patients, full weight bearing was achieved at 20 weeks while only 2 (8%) patients required more than 20 weeks. 80% of cases required less than 16 weeks for union while 20% required more than 16 weeks. Average injury to surgery time was 3.62 days in the present series. Superficial stitch infection occurred in two cases. Deep infection occurred in a grade 2 compound fracture in a male who was treated initially with debridement and antibiotics.Conclusions: Good results are seen by distal femur locking condylar plate alone. It is the main implant of choice for distal femur fractures of all varieties. Best outcome is expected if fracture fixation is done following all the basic principles of fracture fixation. Advantage of the mechanical properties of a locking plate is definitely useful.

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Functional outcome of distal femoral fractures managed surgically using locking compression plate laterally and augmented with titanium elastic nail system medially

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i3.32982 ◽

2021 ◽

Vol 12 (3) ◽

pp. 81-87

Author(s):

Sujay K Mahadik ◽

Sasha Martyres ◽

Mrutyunjay S Gaonkar ◽

Anish W Isapure ◽

Shrikant B Deshpande

Keyword(s):

Functional Outcome ◽

Weight Bearing ◽

Femoral Fractures ◽

Locking Compression Plate ◽

Full Weight Bearing ◽

Titanium Elastic Nail ◽

Femur Fractures ◽

Compression Plate ◽

Elastic Nail ◽

The Mean

Background: Distal femur fractures are generally due to high velocity trauma particularly form road traffic accidents and fall from height. The treatment of distal femur fractures has evolved from conservative to operative to fixation of both lateral and medial columns of femur. Aims and Objective: The aim of this study was to evaluate the functional outcome of operated cases of comminuted fracture of lower end of femur fixed with locking compression plate laterally and augmented with titanium elastic nail system medially. Materials and Methods: The present study was a prospective study carried out in Bharati Vidyapeeth Medical College and Hospital, Sangli after approval from institutional ethical committee. In this study, 20 patients with communited fracture of lower end of femur were included on the basis of a predefined inclusion and exclusion criteria. Detailed history was taken and clinical examination was done in all cases. After preanesthetic evaluation and relevant investigations patients were treated by reduction (close or open) and fixation was done by locking compression plate laterally and augmented with titanium elastic nail system medially. Patients were followed up at 6, 10 and 14 weeks for functional outcome by Neer’s scoring system and degree of flexion at knee joint. Results: Out of 20 studied cases there were 16 (80%) males and 4 (20%) were females with a M:F ratio of 4:1. The mean age of male patients was found to be 42.81+/-14.79 whereas mean age of female patients was 40.5 +/- 14.36. The mean age of male and female patients was found to be comparable with no statistically significant difference (P=0.78). Most of the patient were diagnosed with the fracture of AO TYPE C3 (7 cases), followed by AO TYPE C1 (4 cases). Full weight bearing was achieved in 8 (40%) patients within 18 weeks whereas remaining 12 (60%) patients required more than 20 weeks for full weight bearing. 14 (70%) patients had excellent outcome whereas, Good, Fair and poor outcomes were seen in 4 (20%), 1 (5%) and 1 (5%) patient. On one-way ANOVA analysis, showed that the flexion was significantly higher in 12 weeks as that of the 6 weeks (P =<0.0001). Further the flexion was significantly higher in 24 weeks as that of the 6 and 12 weeks (P =<0.0001). Conclusion: Our study found that locking compression plating laterally augmented with titanium elastic nail system medially for comminuted distal femoral fractures is a good fixation system and provides good angular stability.

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Finite element analysis of double‐plate fixation using reversed locking compression‐distal femoral plates for Vancouver B1 periprosthetic femoral fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04152-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Daisuke Takahashi ◽

Yoshihiro Noyama ◽

Tsuyoshi Asano ◽

Tomohiro Shimizu ◽

Tohru Irie ◽

...

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Plate Fixation ◽

Weight Bearing ◽

Femoral Fractures ◽

Full Weight Bearing ◽

Loading Test ◽

Lateral Plate ◽

Element Analysis ◽

Periprosthetic Femoral Fractures

Abstract Background Internal fixation is recommended for treating Vancouver B1 periprosthetic femoral fractures. Although several fixation procedures have been developed with high fixation stability and union rates, long-term weight-bearing constructs are still lacking. Therefore, the aim of the present study was to evaluate the stability of a double-plate procedure using reversed contralateral locking compression-distal femoral plates for fixation of Vancouver B1 periprosthetic femoral fractures under full weight-bearing. Methods Single- and double-plate fixation procedures for locking compression-distal femoral plates were analysed under an axial load of 1,500 N by finite element analysis and biomechanical loading tests. A vertical loading test was performed to the prosthetic head, and the displacements and strains were calculated based on load-displacement and load-strain curves generated by the static compression tests. Results The finite element analysis revealed that double-plate fixation significantly reduced stress concentration at the lateral plate place on the fracture site. Under full weight-bearing, the maximum von Mises stress in the lateral plate was 268 MPa. On the other hand, the maximum stress in the single-plating method occurred at the defect level of the femur with a maximum stress value of 1,303 MPa. The principal strains of single- and double-plate fixation were 0.63 % and 0.058 %, respectively. Consistently, in the axial loading test, the strain values at a 1,500 N loading of the single- and double-plate fixation methods were 1,274.60 ± 11.53 and 317.33 ± 8.03 (× 10− 6), respectively. Conclusions The present study suggests that dual-plate fixation with reversed locking compression-distal femoral plates may be an excellent treatment procedure for patients with Vancouver B1 fractures, allowing for full weight-bearing in the early postoperative period.

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Functional outcome of fixation of distal femoral fractures with DF-LCP: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164000 ◽

2016 ◽

Vol 2 (4) ◽

pp. 291 ◽

Cited By ~ 1

Author(s):

Shafeed T. P. ◽

Bijo Paul

Keyword(s):

Tissue Injury ◽

Weight Bearing ◽

Soft Tissue Injury ◽

Femoral Fractures ◽

Early Mobilization ◽

Type A ◽

Full Weight Bearing ◽

Supracondylar Fractures ◽

Range Of Movement ◽

Locked Plating

Background: Management of supracondylar fractures is a real challenge to the orthopaedician due to its extensive soft tissue injury, boneloss, comminution, articular extention and instability. Open reduction and internal fixation with anatomical distal femoral locking plate permits early mobilization. Stable anatomical fixation is necessary to avoid complications and disability.Methods: 25 patients with Type A and Type C closed supracondylar femoral fractures were followed up from November 2013 to November 2015. All the patients underwent ORIF with DF-LCP. Clinical and radiological follow up were recorded for 24 months.Results: Mean time for fracture union was 4.02 months. Average duration for full weight bearing was 122 days (range 90-180days). The average range of movement for Type A fractures was 105.71 degrees, for C fractures average ROM was 93.64 degrees. Average ROM for patients <50 was 103 degree and for patients>50 ROM was 98.66 degree. Conclusions: Locked plating of DF fractures permits stable fixation and early mobilization which avoids disability and ensures good joint function.

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Violation of consolidation of the femur after untimely dynamization of the intramedullary blocking rod

ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS ◽

10.15674/0030-59872021169-72 ◽

2021 ◽

pp. 69-72

Author(s):

Diomyd Chabanenko ◽

Oleksandr Polіvoda

Keyword(s):

Femoral Fracture ◽

Distal Part ◽

Weight Bearing ◽

Femoral Fractures ◽

Femoral Shaft ◽

Joint Control ◽

Posterior View ◽

Intramedullary Osteosynthesis ◽

Fracture Consolidation ◽

The Right

Violation of femoral fracture consolidation after blocking intramedullary osteosynthesis is a fairly common pathology, and requires the attention of physicians due to its prevalence. There are several reasons for this complication: it is the instability in the system «bone-implant», and the untimely dynamization of the locking nail. Methods. This article presents a case of fracture violated consolidation after blocking intramedullary osteosynthesis caused a nonunion due to nail failure. Results. Patient was injured on 29.12.2018, as a result of a traffic accident. 01.15.2019, the surgery was performed: closed reduction, blocking intramedullary osteosynthesis of the fracture of the middle shaft of the right thigh, static fixation of the nail. Next visit to the clinic was on 02.01.2020, because of pain in the middle third of the thigh, problems with axial weight-bearing on the right leg, limitation of the flexion in the right knee joint. Control radiographs demonstrated no signs of consolidation of the femoral shaft fracture, and migration of the distal locking screw. 08.01.2020 revision surgical treatment was performed. Given the presence of 5 mutually perpendicular holes in the distal part of the nail, two of them were locked in the anterio-posterior view by the free hand method, the migrated screw in the distal part of the nail was replaced, and the nail was dynamized in the proximal part taking into account its design features. Conclusions. To normalize the consolidation processes in patients with nonunion femoral fractures, bone physiology and the positive effect of autocompression should be considered. The described case demonstrates the necessity for timely dynamization of the blocking nail, which confirms our own observations and literature data. Despite the fact that the dynamization of the nail was performed 1 year after blocking intramedullary osteosynthesis, fracture consolidation occurred 5 months after its implementation. Key words. Femoral fracture, blocked intramedullary osteosynthesis, disorders consolidation, dynamization of the construction.

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Comparison of Titanium Elastic Nailing and End-threaded Intramedullary Pinning for Distal Femoral Fractures in Young Dogs

Indian Journal of Animal Research ◽

10.18805/ijar.b-4454 ◽

2021 ◽

Author(s):

Harmanpreet Singh Sodhi ◽

Ashwani Kumar ◽

Arun Anand ◽

Vandana Sangwan ◽

Opinder Singh

Keyword(s):

Stainless Steel ◽

Functional Outcome ◽

Weight Bearing ◽

Femoral Fractures ◽

Titanium Implants ◽

Early Weight Bearing ◽

Femur Fractures ◽

Elastic Nails ◽

Group 2 ◽

Group 1

Background: Femur fractures are common in immature dogs. As compared to stainless steel, titanium implants are lighter and allow controlled micro-motion at the site of fracture that stimulates early callus formation by limiting stress shielding. Cited literature reports successful clinical use of titanium elastic nails for the stabilization of long bone fractures in young human patients; however, there is paucity of information on this technique is dogs. This study was planned with an objective to compare titanium elastic nails (TENS) and single end-threaded pin for the management of femoral fractures in young dogs. Methods: The study included 20 clinical cases (10 male and 10 female) of dogs suffering from distal femoral fracture with a mean ± SD age of 5.70 ± 5.60 month, body weight 11.09 ± 4.48 Kg since 3.05 ± 2.35 days. The cases were divided into 2 groups; using TENS (n=10; group 1) and stainless steel end-threaded intramedullary pin (n=10; group 2). Result: Group 1 dogs demonstrated better fracture reduction score, early and uniform callus and better implant stability as compared to group 2, radiographically. Early weight bearing and minimum postoperative complications with better functional outcome including joint mobility was reported in group 1. In conclusions, TENS is superior fracture fixation technique for the repair of supracondylar or distal third femur fractures in young dogs with better functional outcome, minimal stiffness of stifle joint and early weight bearing, in comparison to single end threaded intramedullary pin.

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A study on clinical outcomes of complex subtrochanteric femoral fractures with cephalomedullary nail

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214188 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1194

Author(s):

S. F. Kammar ◽

Karthik B. ◽

V. K. Bhasme ◽

Suryakanth Kalluraya

Keyword(s):

Clinical Outcomes ◽

Road Traffic ◽

Weight Bearing ◽

Femoral Fractures ◽

Lateral View ◽

Successful Outcome ◽

Harris Hip Score ◽

Full Weight Bearing ◽

Subtrochanteric Fractures ◽

The Mean

Background: The aim of the study was to evaluate the clinical outcomes of complex subtrochanteric fractures treated by using cephalomedulary nail.Methods: This is a prospective observational study of 30 cases of complex subtrochanteric femoral fractures admitted to our hospital from January 2018 to June 2019. Cases were taken according to the inclusion and exclusion criteria i.e. type IV, type V Seinsheimer’s classification, above 18 years and those who are willing to participate in the study has been included and pathological fractures, open fractures were excluded. All the patients are followed up on 2 post-operative day, after 4 weeks, 8 weeks, 12 weeks and 6months. X-ray hip with thigh anteroposterior (AP) and lateral view taken during each follow up. Out comes was assessed using modified Harris hip score.Results: In our study of 30 cases there are 22 males and 8 females and the mean age of 43.7 years. 73.3% patients are due to Road traffic accidents predominance of right side. In our study 66% had type 4 Seinsheimers and 34% cases had type 5 Seinsheimers fracture. The mean duration of hospital stay was 17 days. Mean time for full weight bearing is 12 weeks. Good to excellent results are seen in 80% of type 4 subtrochanteric fractures and 75% of cases of type 5 subtrochanteric fractures. 4 cases had surgical site infection, 3 cases had varus, 1 case had developed implant failure, and 1 case had reverse Z effect.Conclusions: From this study, we conclude that proximal femoral nail is an excellent implant in the treatment of complex subtrochanteric femoral fractures the terms of successful outcome include a good understanding of fracture biomechanics, good preoperative planning and accurate instrumentation.

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