Elastic Stable Intramedullary Nailing in Length Stable Versus Unstable Pediatric Femoral Shaft Fractures: A Comparison of Clinical, Radiographic, and Pedobarographic Outcomes.

IF 1.4 3区 医学 Q3 ORTHOPEDICS
Journal of Pediatric Orthopaedics Pub Date : 2024-09-01 Epub Date: 2024-05-29 DOI:10.1097/BPO.0000000000002737
Hilmi Alkan, Yalçin Turhan, Enejd Veizi, Ömer Faruk Naldoven, Berke Aras, Ufuk Gürsoy Kanlikaya, Güney Yilmaz, Senol Bekmez
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引用次数: 0

Abstract

Background: Pediatric diaphyseal femoral fracture (PDFF) is one of the most common injuries requiring hospitalization. Elastic stable intramedullary nailing (ESIN) is commonly used for PDFFs in ages 5 to 11. The optimal treatment method for length unstable PDFF is a subject of ongoing debate. This study aimed to compare clinical, radiographic, and pedobarographic outcomes of ESIN between length stable and unstable PDFF.

Methods: We retrospectively reviewed patients undergoing ESIN treatment for isolated PDFF between 2016 and 2021. Exclusion criteria were (1) history of ipsilateral or contralateral lower extremity fractures, (2) highly comminuted or segmental fractures, (3) body weight >50 kg, and (4) comorbidities affecting bone quality, range of motion, or neurologic status. The patients were divided into 2 groups according to length stability. Clinical, radiographic, and pedobarographic data were then assessed to compare groups.

Results: Twenty-five patients were included (17 length stable and 8 length unstable PDFF) with a mean age of 73.6±17.8 months. There was no significant difference between groups in age, side of injury, body weight, follow-up duration, and nail-canal diameter ratio. Mean deformity in the fracture site in the early postoperative x-rays was not significantly different between groups ( P =0.661). After a mean follow-up of 27.8±14.2 months (range, 12-67), there was no significant difference in mechanical axis deviation, distal femur joint orientation angle, or limb-length discrepancy in both groups. The pedobarographic assessment revealed that the length unstable group had a significantly higher external foot progression angle in the injured extremity (9.8°±6.9° vs. 1.3°±5.6°, P =0.031). However, the length stable group had no significant difference in the foot progression angle (4.9°±5° vs. 3°±4.3°, P =0.326). There was no significant difference in either group for other pedobarographic parameters.

Conclusion: ESIN is a safe and effective option for length-unstable PDFF, yet attention should be paid to the rotational alignment. Although significant external rotation deformity occurs in length-unstable PDFF, it has no implications for the other pedobarographic parameters.

Level of evidence: Level IV.

弹性稳定髓内钉在长度稳定与不稳定小儿股骨柄骨折中的应用:临床、X 射线和髋臼造影结果比较。
背景:小儿股骨骺骨折(PDFF)是需要住院治疗的最常见损伤之一。弹性稳定髓内钉(ESIN)常用于治疗 5-11 岁儿童的股骨骺骨折。长度不稳定型 PDFF 的最佳治疗方法一直存在争议。本研究旨在比较长度稳定型和长度不稳定型 PDFF 在 ESIN 治疗后的临床、影像学和畸形学结果:我们回顾性研究了 2016 年至 2021 年期间因孤立 PDFF 而接受 ESIN 治疗的患者。排除标准为:(1)有同侧或对侧下肢骨折史;(2)高度粉碎性或节段性骨折;(3)体重大于 50 千克;(4)有影响骨质、活动范围或神经状态的合并症。根据长度稳定性将患者分为两组。然后评估临床、放射学和足底造影数据,对各组进行比较:共纳入 25 名患者(17 名长度稳定型和 8 名长度不稳定型 PDFF),平均年龄为 73.6±17.8 个月。组间在年龄、受伤侧、体重、随访时间和钉孔直径比等方面无明显差异。术后早期X光片显示的骨折部位平均畸形程度在组间无明显差异(P=0.661)。平均随访27.8±14.2个月(12-67个月)后,两组患者的机械轴偏差、股骨远端关节定向角或肢长差异无明显差异。足底摄影评估显示,长度不稳定组患者受伤肢体的足外展角度明显更高(9.8°±6.9° vs. 1.3°±5.6°,P=0.031)。然而,长度稳定组的足外展角无明显差异(4.9°±5° vs. 3°±4.3°,P=0.326)。结论:ESIN是一种安全有效的选择:结论:ESIN是治疗长度不稳定的PDFF的一种安全有效的方法,但应注意旋转对位。尽管长度不稳定的 PDFF 会出现明显的外旋畸形,但这对其他足底形态参数没有影响:证据等级:IV级。
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来源期刊
CiteScore
3.30
自引率
17.60%
发文量
512
审稿时长
6 months
期刊介绍: ​Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.
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