Different Types of Femoral Shaft Fracture; Different Types of Treatment: Their Effects on Postoperative Lower Llimb Discrepancy

• Authors: Mohammad Fakoor , Shahnam Mousavi , Hazhir Javherizadeh
• Languages of publication: EN

Abstracts

EN

Femoral shaft fracture in child is a disabling injury. Different methods of treatment can be used for femoral shaft fracture and depends on patient condition.The aim of the study was to evaluate lower limb discrepancy following different method of treatment and possible related factors especially type of fractures.Material and methods. This retrospective cross sectional study was carried out in Imam Khomeini and Razi Hospital from 2003-2007 on children admitted to hospital with femur fracture. All children aged <12 years of age with diagnosis of femoral shaft fracture were included in this study. Different methods of treatment were flexible intramedullary nailing, rigid intramedullary nailing with Steinmann pin and spica casting, spica casting and closed reduction, and ORIF with plate and screw. Distance from hip to knee for each patient was determined in scanograms. Sex, age, side of involvement, type of fracture were recorded for each case. Analysis was done with SPSS ver. 16.0. ANOVAs, Chi-Square, and t-Test were used with CI=95%.Results. In this study, 253 cases (M=182, F=71) were included. One hundred forty-six (57.7%) cases had right involvement and 107 (42.3%) of cases had left side involvement. From all cases, 135(53.4%) cases had no changes in lower limb length. Eleven (4.3%) cases had lower limb shortening and 107(42.3%) cases had lower limb lengthening. Type A1 and type A2 showed greatest lower limb discrepency among cases who underwent ORIF with screw & plate fixation, and spica casting with closed reduction respectively (p<0.05).Conclusions. There is significant difference among surgical and non surgical treatment for LLD. Spica casting and closed reduction has the least changes compared to other methods. Sex, side of involvement, type of fracture, and location had no effect in post operative length changes. Type of fracture, only, has a role in screw and plate fixation group and this is may be due to the differences between A1 and A3 fractures. Most of the changes were seen in the range of 60 through 120 months of age. Most of the changes were in the range +10 to +20 mm.

Keywords

EN

femoral shaft fractures; intra-medullary nailing; leg lenght discrepancy; children; screw and plate

• Publisher: De Gruyter Open
• Journal: Polish Journal of Surgery
• Year: 2011
• Volume: 83
• Issue: 9
• Pages: 477-481

Dates

published

1 - 9 - 2011

online

5 - 10 - 2011

Contributors

author

Mohammad Fakoor

• Department of Orthopedic Surgery, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

author

Shahnam Mousavi

• Department of Orthopedic Surgery, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

author

Hazhir Javherizadeh

• Arvand International Division, Ahvaz Jundishapur University of Medical Sciences, Iran

References

• Salem KH, Lindemann I, Keppler P: Flexible intramedullary nailing in pediatric lower limb fractures. J Pediatr Othop 2006;26:505-09.[Crossref]
• Kasser JR: Femoral shaft fractures. In: Rockwood CA Jr, Wilkins KE, Beaty JE (eds) Fractures in children. Lippincott, Philadelphia 1996: 1195-1230.
• Fry K, Hoffer MM, Brink J: Femoral shaft fracture in brain injury children. J Trauma 1976: 16(5): 371-73.[Crossref][PubMed]
• Landin LA: Fracture patterns in children: analysis of 8682 fractures with special reference to incidence, etiology and secular changes in Swedish urban population, 1950-1979. Acta Orthop Scand Suppl 1983; 202: 1-109.
• Buess E, Kaelin A: One hundred pediatric femoral fracture: epidemiology, treatment attitudes, and early complication. J Pediatric Orthop Br 1998; 186-92.
• McCartney D, Hinton A, Heinrich SD: Operative stabilization of pediatric femur fractures. Orthop Clin North Am 1994; 25(4): 635-50.[PubMed]
• Sahlin Y: Occurrence of fractures in a defined population: a 1-year study. Injury 1990; 21(3): 158-60.[Crossref]
• Curtis JF, Kilian JT, Alonso JE: Improved treatment of femoral shaft fractures in children utilizing the pontoon spica cast: a long term follow-up. J Pediatr Orthop 1995; 15(1): 36-40.[Crossref]
• Kirby RM, Winquist RA, Hansen ST: Femoral shaft fractures in adolescents: a comparison between traction plus cast treatment and closed intramedullary nailing. J Pediatr Orthop 1981; 1(2): 193-97.[Crossref][PubMed]
• Marsh JL, Slongo TF, Agel J et al.: Fracture and dislocation classification compendium 2007: Orthopedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 2007; 21(10 Suppl): S1-133. 10: (21): Supplement: S31-S42.[WoS]
• Holschneider AM, Vogl D, Dietz HG: Differences in leg length following femoral shaft fractures in children. Z Kinderchir 1985; 40(6): 341-50.[PubMed]
• Czertak DJ, Hennrikus WL: The treatment of pediatric femur fractures with early 90-90 spica casting. J Pediatr Orthop 1999; 19(2): 229-32.[PubMed]
• Thompson JD, Buehler KC, Sponseller PD et al.: Shortening in femoral shaft fractures in children treated with spica cast. Clin Orthop Relat Res 1997; (338): 74-78.
• Anastasopoulos J, Petratos D, Konstantoulakis C et al.: Flexible intramedullary nailing in paediatric femoral shaft fractures. Injury 2010; 41(6): 578-82.[WoS][Crossref]
• Allen BL, Kant AP, Emery FE: Displaced fractures of the femoral diaphysis in children: definitive treatment in a double spica cast. J Trauma 1977; 17(1): 8-19.
• Schonk JW: Comparative follow-up study of conservative and surgical treatment of femoral shaft fractures in children. Arch Chir Neerl 1978; 304: 231-38.
• Barford B, Christensen J: Fractures of the femoral shaft in children with special reference to subsequent overgrowth. Acta Chir Scand 1958-1959; 116: 235-50.
• Henderson OL, Morrissy RT, Gerdes MH et al.: Early casting of femoral shaft fractures in children. J Pediatr Orthop 1984; 4(1): 16-21.[Crossref]
• Wright JG: The treatment of femoral shaft fractures in children: a systematic overview and critical appraisal of the literature. Can J. Surg 2000; 43(3): 180-89.[PubMed]
• Fass J, Kaufner HK: Follow up and late result following treatment of childhood femoral shaft fractures. Zentralbl Chir 1985: 110(23): 1436-48.
• Hehl G, Keifer H, Bauer G et al.: Post traumatic leg length inequality after conservative and surgical therapy of pediatric femoral shaft fractures in childhood. Unfallchirurg 1993; 96(12): 651-55.
• Wessel L, Syfriedt C: Leg length inequality after childhood femoral fractures, permanent or temporary phenomenon. Unfallchirurg 1996 Apr; 99(4): 275-82.[PubMed]
• Kohan L, Cummings WJ: Femoral shaft fracture in children: the effect of initial shortening on subsequent overgrowth. Aust NZ J Surg 1982; 52(2): 141-44.[Crossref]
• Meals RA: Overgrowth of the femur following fracture in children: influence of handedness. J Bone Joint Surg 1979; 61(3): 381-84.
• Kerettek C, Haas N, Walker J et al.: Treatment of femoral shaft fracture in children by external fixation. Injury 1991; 22: 263-66.[Crossref]
• Bohn WW, Durbin RA: Ipsilateral fractures of the femur and tibia in children and adolescents. J Bone Joint Surg Am 1991; 73A(3): 429-39.
• Burton VW, Fordyce AJ: Immobilization of femoral shaft fractures in children aged 2-10 years. Injury 1972; 4(1): 47-53.[PubMed]

Identifiers

DOI

10.2478/v10035-011-0074-9