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 : official publication of the European Trauma Society Pub Date : 2022-10-01 Epub Date: 2021-08-02 DOI:10.1007/s00068-021-01752-7

Stijn van Cruchten, Eefke C Warmerdam, Dagmar R J Kempink, Victor A de Ridder

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引用次数: 12

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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2-10岁儿童闭合性股骨干骨折的治疗:系统回顾和荟萃分析。

目的:回顾目前关于2-10岁儿童闭合性股骨干骨折治疗的文献，并对2-6岁儿童进行亚组分析，比较髓内钉(IMN)与保守治疗方式。方法:我们纳入了临床试验和观察性研究，比较牵引和后续铸造(TSC)、spica铸造和IMN治疗2-10岁儿童股骨骨干骨折的效果。对2 ~ 6岁儿童进行亚组分析。结果:与即刻spica铸造治疗相比，IMN显著减少冠状面成角(平均差值(MD): 2.03度，可信区间(CI) 1.15-2.90)，减少矢状面成角(MD: 1.59度，CI 0.82-2.35)，降低LLD发生率(风险差值(RD): 0.07, CI 0.03-0.11)。在康复方面，IMN可缩短患者到辅助行走所需时间(MD: 31.53 d, CI 16.02-47.03)，缩短患者到独立行走所需时间(MD: 26.59 d, CI 22.07, 31.11)，缩短患者到完全负重所需时间(MD: 27.05 d, CI 6.11, 47,99)。与TSC相比，IMN导致较低的不愈合率(RD: 0.31, CI 0.05-0.56)，较短的住院时间(MD: 12.48天，CI 11.57, 13.39)，到辅助行走的时间(MD: 54.55, CI 40.05-69.04)和完全负重(MD: 27.05天[6.11,47,99])。结论:虽然缺乏高质量的证据，但本系统综述显示弹性髓内钉治疗2-10岁儿童股骨干骨折有明显的趋势。证据等级:3;

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European journal of trauma and emergency surgery : official publication of the European Trauma Society

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