- Discussion:
-
methods to enhance fixator stability;
- in the report by T Minor et al, 37 femoral shaft fractures, in 33 pediatric patients, were treated with unilateral external
fixation after reduction from 1992 through 1998 (ages from 4 to 14 years);
- average follow-up was 3 years, 9 months, with only five children lost to follow-up;
- average duration in fixator was 107 days;
- 36 of 37 fractures healed, and there was one delayed union;
- there was minimal angulation, and limb-length inequality was generally <1 cm; 72.7% had pin-tract infections.
- 8 (21.6%) patients refractured; four occurred in the four patients with bilateral femur fractures;
- children with bilateral femur fractures were at greatest risk.
- ref: Outcomes of external fixation of pediatric femoral shaft fractures.
Miner T, Carroll KL
J Pediatr Orthop 2000 May-Jun;20(3):405-10
-
external fixation vs flexible nails:
- in the study by E. Bar-on et al 1997, flexible IM nails were compared to external fixation in a prospective study;
- consisted of a prospective study w/ 20 patients w/ age ranges from 5-15 years;
- in their study, time to full wt bearing, ROM, and return to school were all faster in the flexibile nail group;
- nails were inserted from the proximal end for more proximal fractures and from the distal end for more distal fractures;
- there were no cases of limb length inequality nor malunion in the nail group;
- Complications:
- upto 50% of patients may experience superficial pin tract infections, but most of these
can be treated w/ PO antibiotics and will not require removal of the fixator;
- refracture may occur in 5-10% of patients (this may be prevented with dynamization of
the external fixator within 2-4 weeks, depending on the stability of the fracture;
- fracture thru a pin site is another complication which can occur if drill holes are not applied carefully;
- half pins should be less than 1/3 the diameter of the femur, inorder to lessen the chance of frx;
- in the report by T Minor et al, 8 (21.6%) patients refractured; four occurred in the four patients with bilateral femur fractures;
- children with bilateral femur fractures were at greatest risk.
- ref: Outcomes of external fixation of pediatric femoral shaft fractures.
Miner T, Carroll KL
J Pediatr Orthop 2000 May-Jun;20(3):405-10
External fixation of pediatric femoral fractures.
Remodelling of angular deformity after femoral shaft fractures in children.
The use of external fixators in femur fractures in children.
N. de Sanctis et al.
JPO. Vol 16(5). 1996. p 613-620.
Complex femur fractures in children: treatment with external fixation.
D Kirschenbaum et al.
JPO. Vol 10(5) 1990. p 588-591.
External fixation of femur fractures in children.
J Aronson and EA Tursky.
JPO. Vol 12(2) 1992. p 157-163.
Radiological outcome after external fixation of 97 femoral shaft fractures in children.
External fixation of displaced femoral shaft fractures in children: a consecutive study of 98 fractures.
Is external fixation in pediatric femoral fractures a risk factor for refracture?
