Surgical treatment pediatric femur shaft fracture: early and late complication

Abstract

Pediatric femoral fractures is a topical issue of modern pediatric traumatology. They are among the most common fractures of long bones and are the most common orthopaedic injury requiring hospitalization. Treatment of femur fractures in children vary on the basis of the mechanism of injury, the patient’s age, weight, the fracture pattern, family circumstances, and cost. Non-operative management plays a role in some cases but operative fixation as it allows early mobilisation and shorter hospital stays.

Purpose – to analyze our experience in surgical treatment pediatric femoral shaft fractures with different methods, early and late complication.

Materials and methods. For the period from 2008 to 2019, 148 children with acute femur shaft fractures were treated in our department, pathological fractures were exclude. They were divided according to surgical approach into 4 groups: elastic intramedullary nail (ESIN) – 109 patients (113 femurs), intramedullary locking nail (IMN) – 27 patients (27 femurs), external fixator – 8 patients (8 femurs), and plating – 4 (4 femurs). Comparisons were made between 2 groups: intramedullary nailing with closed reduction (124 femurs) and open reduction (16 femurs), of which 102 male and 38 female; aged of patients was 6–17 years. Hospitalization time of – up to 24 hours – 92 (63 boys, 29 girls), 1–7 days – 56 (39 boys, 17 girls). The indication for the use of flexible intramedullary rods was the age of children under 14 years of age with a weight of no more than 50 kg; in children of the older age group, an intramedullary blocked rod with an insertion point through the apex of the greater trochanter was used.

Results. Flexible intramedullary nailing was used in 109 (74%) by standard retrograde technique 102 patients (106 femurs) and antegrade technique 7 patients (7 femurs), closed reduction was done in 121 patients (124 femur), open reduction in 15 patients (16 femurs). A blocking intramedullary rod was used in 27 children of the older age group, which amounted to 18%. Aseptic necrosis of the femoral head or changes in the proximal femur was not observed in any patient. There were only 4 (3%) children in the plating group, one case had refracture, 2 cases had infection. In all patients, except one with polytrauma, complete consolidation of the fracture was observed. The duration of the operation, the time of stay in the hospital, the amount of blood loss and postoperative pain were significantly lower in the group with closed reduction technique than in the group where the open reduction of the fragments was used. The dependence of the results of treatment and the beginning of the axial load on the affected limb on the duration of surgery was not found. Most common early complication was soft tissue irritation at the nail entry site (32 patients – 18 boys, 14 girls). Varus deformity of the femur was observed in 9 children (5 boys, 4 girls), in one patient this deformity was combined with limb shortening, valgus deformity was found in 3 patients (2 boys, 1 girl), rotational deformity in 2 patients (2 girls). According to Flynn’s criteria, only 2 patients had a poor result.

Conclusions. Titanium elastic nailing is a relatively simple, minimally invasive method of surgical treatment of fractures of the shaft femur in children and adolescents with high rates of good and excellent results. For children of the older age group use of an intramedullary blocked nail is a safe procedure without the development of any changes in the proximal femur. The research was carried out in accordance with the principles of the Helsinki declaration.

The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.

No conflict of interest was declared by the authors.