Close Versus Limited Open Method of Ender’s Nail Fixation in Paediatric Femoral Shaft Fractures

Introduction: There are various surgical options for treating fracture of femoral shaft in children. Here we compare the results of close with limited open method of Ender’s nails fixation of femoral shaft fractures in children. Methods: We studied 60 children with femoral shaft fractures in age group 5-15 years. Ender’s nail fixation was done by close technique in 40 cases and in 20 cases by limited open technique. Results: The mean operative time was significantly high in limited open group being 64 minutes in comparison to 50 minutes in close group. There was no significant difference between close and limited open groups with respect to time for partial weight bearing and time for full weight bearing. Fracture united sooner in close group as compared to open group. Union was achieved in all patients within a mean of 11 weeks in close group in comparison to 12.4 weeks in open group. According to the Flynn criteria in close group 34 patients had excellent results, 6 had satisfactory and none poor. In limited open group outcome was excellent in 14 patients, satisfactory in 4 patients and 2 had poor result. There was no significant difference in outcome based on Flynn criteria between two groups. Conclusions: Though operative time is more and healing is delayed in Ender’s nail fixation by limited open technique, there is no statistical difference in final outcome as per Flynn criteria between close and limited open technique of Ender’s nail fixation of femoral shaft fractures in children. Keywords: children; close technique; ender’s nail; fracture shaft of femur; flynn criteria.

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Four Weeks in a Single-Leg Weight-Bearing Hip Spica Cast is Sufficient Treatment for Isolated Femoral Shaft Fractures in Children Aged 1 to 3 Years

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000000523 ◽

2016 ◽

Vol 36 (7) ◽

pp. 680-684 ◽

Cited By ~ 7

Author(s):

Sami Jaafar ◽

Ali Sobh ◽

Julie E. Legakis ◽

Ronald Thomas ◽

Kelsey Buhler ◽

...

Keyword(s):

Weight Bearing ◽

Femoral Shaft ◽

Spica Cast ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Fractures In Children ◽

Hip Spica Cast

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Epidemiology of femoral shaft fratures in Poland

Przeglad Epidemiologiczny ◽

10.32394/pe.74.43 ◽

2020 ◽

pp. 492-502

Keyword(s):

Age Groups ◽

Femoral Shaft ◽

The Elderly ◽

High Energy ◽

Polish Population ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Fractures In Children ◽

Total Incidence ◽

Significant Difference

INTRODUCTION. Femoral shaft fractures are undoubtedly a common issue in orthopedic practice, which frequently requires surgical treatment. The clinical significance of such fractures is high, but the statistics of their occurrence was not covered in any comprehensive study in Polish medical literature. THE AIM OF THE STUDY. The study aimed to assess the incidence of femoral shaft fractures in the Polish population with particular reference to the mechanism of such events in pediatric patients. MATERIAL AND METHODS. The assessment of the total incidence and the incidence in individual age groups was performed basing on data concerning 2015-2018 obtained from the National Health Fund. Data regarding the mechanism of the event were obtained at the Pediatric Teaching Clinical Hospital, University Clinical Center of the Medical University of Warsaw. RESULTS. We assessed the total incidence at the level of 10.5 cases per 100 000 inhabitants yearly in Poland. A significant difference was noted in the incidence in individual age groups, particularly in the elderly. The incidence of femoral shaft fractures in patients older than 70 was twofold higher than in the general population. The paper also tackles the issue of mortality in patients with femoral shaft fractures, which reaches 16% annually. High-energy trauma was responsible for the majority of femoral shaft fractures in children with the dominant activity being trampoline jumping. At the same time, the incidence was comparable between boys and girls. CONCLUSIONS. The obtained results were discussed against statistics concerning other countries with the outcomes being rather similar. No significant differences were observed as regards the Polish population versus populations of other countries.

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TENS for the surgical management of femoral shaft fractures in 6-14 years age group children

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors5213-21 ◽

2017 ◽

Vol 5 (2) ◽

pp. 13-21

Author(s):

Mohit Khanna ◽

Jitendra Wadhwani ◽

Amit Batra ◽

Sidharth Yadav ◽

Sarfraz Iman ◽

...

Keyword(s):

Prospective Study ◽

Weight Bearing ◽

Femoral Shaft ◽

Full Weight Bearing ◽

External Fixators ◽

Age Group ◽

Femoral Shaft Fractures ◽

Femur Fractures ◽

Shaft Fractures ◽

Fractures In Children

Background. Fracture shaft of femur in pediatric age group is one of the most common leading emergencies. Children in the age group of 6-14 years are treated with either traction, hip spica, flexible/elastic stable retrograde intramedullary nail, or external fixators. We conducted a clinical prospective study on the use of Titanium Elastic Nailing System (TENS) for the treatment of femoral shaft fractures in children. Methods. The prospective study included 45 cases of fresh femoral shaft fractures. The Inclusion Criteria were a) Age group of 6-14 years, b) Recent fracture of femur shaft c) Transverse, short oblique, minimally comminuted fractures. Results. The clinical results were evaluated using Flynn’s criteria of scoring as, Excellent in 40 patients (88.89 %), Satisfactory in 5 patients (11.12 %) and poor in none. Radiological criteria for fracture union were assessed by using Anthony et al scale. Nine patients developed bursitis at entry point of the nail. Three patients had superficial infection due to bursitis. Full weight bearing was possible in mean time of 8.7 weeks (range; 7-12 weeks). Conclusion. TENS is very effective in management of paediatric shaft femur fractures in the age group of 6-14 years with advantages of early union, early mobilization and manageable complications.

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Treatment of closed femoral shaft fractures in children aged 2–10 years: a systematic review and meta-analysis

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01752-7 ◽

2021 ◽

Author(s):

Stijn van Cruchten ◽

Eefke C. Warmerdam ◽

Dagmar R. J. Kempink ◽

Victor A. de Ridder

Keyword(s):

Systematic Review ◽

Subgroup Analysis ◽

Weight Bearing ◽

Femoral Shaft ◽

Treatment Modalities ◽

Full Weight Bearing ◽

Femoral Shaft Fractures ◽

Spica Casting ◽

Shaft Fractures ◽

Fractures In Children

Abstract Objective To review current literature on treatment of closed femoral shaft fractures in children of 2–10 years old, with subgroup analysis of children aged 2–6 years, comparing intramedullary nailing (IMN) to conservative treatment modalities. Methods We included clinical trials and observational studies that compared traction and subsequent casting (TSC), spica casting and IMN for treatment of femur shaft fractures in children of 2–10 years of age. Subgroup analysis of children aged 2–6 years was performed. Results Compared to treatment with immediate spica casting, IMN led to significantly less coronal angulation (mean difference (MD): 2.03 degrees, confidence interval (CI) 1.15–2.90), less sagittal angulation (MD: 1.59 degrees, CI 0.82–2.35) and lower rates of LLD (Risk difference (RD): 0.07, CI 0.03–0.11). In terms of rehabilitation, IMN leaded to shorter time until walking with aids (MD: 31.53 days, CI 16.02–47.03), shorter time until independent ambulation (MD: 26.59 days, CI 22.07, 31.11) and shorter time until full weight bearing (MD: 27.05 days, CI 6.11, 47,99). Compared to TSC, IMN led to a lower rate of malunion (RD: 0.31, CI 0.05–0.56), shorter hospital stays (MD: 12.48 days, CI 11.57, 13.39), time until walking with aids (MD: 54.55, CI 40.05–69.04) and full weight bearing (MD: 27.05 days [6.11, 47,99]). Conclusion Although a lack of quality evidence, this systematic review showed a clear tendency to treatment with elastic intramedullary nails of femoral shaft fractures in children of 2–10 years of age. Level of evidence 3.

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Ischial Weight Bearing Brace after Skin Traction for Treatment of Femoral Shaft Fractures in Children

Journal of the Korean Fracture Society ◽

10.12671/jksf.2000.13.4.1038 ◽

2000 ◽

Vol 13 (4) ◽

pp. 1038

Author(s):

Dong Heon Kim ◽

Jae Jin Oh ◽

Joonho Yang

Keyword(s):

Weight Bearing ◽

Femoral Shaft ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Fractures In Children ◽

Skin Traction

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Comparative study of titanium elastic nailing versus hip spica in treatment of femoral shaft fractures in children

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20163122 ◽

2016 ◽

Vol 2 (3) ◽

pp. 154 ◽

Cited By ~ 1

Author(s):

Dharam Pal Verma ◽

Rahul Kumar Chandan ◽

R. C. Meena ◽

S. L. Sharma

Keyword(s):

Weight Bearing ◽

Femoral Fractures ◽

Femoral Shaft ◽

Delayed Union ◽

Spica Cast ◽

Femoral Shaft Fractures ◽

Titanium Elastic Nailing ◽

Shaft Fractures ◽

Fractures In Children ◽

Hip Spica Cast

Background: There is no consensus on treatment of closed femoral-shaft fractures in children. We compared hip spica cast with titanium elastic nailing (TEN) in the treatment of femoral-shaft fractures in children.Methods: Study was conducted at SMS Medical College, Jaipur (Rajasthan). Out of 90 Patients of diaphyseal fracture femur, 45were treated conservatively by spica cast and 45 were treated with TEN. Follow up done regularly up to twelve months of injury with taking into account, various parameters.Results: All diaphyseal fractures of femur healed, whether treated conservatively by spica cast or treated operatively with TEN. The time of union and weight bearing was less in operative group as comparative to spica cast group. Ten patients (22.22%) in spica group compared to three patients (6.66%) in operative group had malunion and two patients (4.4%) in spica group compared none in operative group had delayed union.Conclusions: Results of TEN turned out to be far superior to traction and spica cast treatment in paediatric femoral fractures. Rate of complications was far low with operative than conservative Treatment.

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