Cargando…

ESIN in femur fractures in children under 3: is it safe?

BACKGROUND: Pediatric femur fractures are a major trauma in children. Different treatment algorithms have been developed but indications for surgical treatment, especially in very young patients, are still controversial. Literature recommends surgical stabilization with elastic-stable intramedullary...

Descripción completa

Detalles Bibliográficos
Autores principales: Cintean, Raffael, Eickhoff, Alexander, Pankratz, Carlos, Strauss, Beatrice, Gebhard, Florian, Schütze, Konrad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9532282/
https://www.ncbi.nlm.nih.gov/pubmed/35394142
http://dx.doi.org/10.1007/s00068-022-01965-4
_version_ 1784802087537737728
author Cintean, Raffael
Eickhoff, Alexander
Pankratz, Carlos
Strauss, Beatrice
Gebhard, Florian
Schütze, Konrad
author_facet Cintean, Raffael
Eickhoff, Alexander
Pankratz, Carlos
Strauss, Beatrice
Gebhard, Florian
Schütze, Konrad
author_sort Cintean, Raffael
collection PubMed
description BACKGROUND: Pediatric femur fractures are a major trauma in children. Different treatment algorithms have been developed but indications for surgical treatment, especially in very young patients, are still controversial. Literature recommends surgical stabilization with elastic-stable intramedullary nailing (ESIN) starting at the age of 3 and non-operative treatment in younger patients. This study sought to present the outcome of patients younger than 3 years of age treated with ESIN for femur fractures. MATERIALS AND METHODS: Inclusion criteria were patients younger than 3 treated with ESIN in femur fractures. Patient demographics, fracture characteristics, mechanism of injury, outcomes and complications were recorded using charts and X-rays. Primary outcome measures were time to mobility, fracture consolidation and surgical-related complications. RESULTS: Between 2010 and 2020, 159 patients were treated with ESIN in femur fractures in our institution. A total of 30 patients met the criteria. The mean age was 2.1 ± 0.7 years (13 months–2.9 years). Most common mechanism was fall from standing height (60%). Other mechanisms were motor vehicle accidents as a pedestrian (10%) or as a passenger (10%) as well as direct blow trauma (20%). Femoral shaft fracture was the most common injury (80%). 5 subtrochanteric and one distal metaphyseal femur fractures were found. Mean length of stay was 2.0 ± 1.3 days. Radiographic controls were performed on day 1, 14 and 6 weeks after surgery if not otherwise specified or if complications occurred. 4.6 ± 1.2 (n 2–7) X-rays were performed on average after surgery. First radiographic consolidation signs were seen after 2.4 ± 0.6 weeks. Only one child showed surgical-related complication with a leg length discrepancy of 1 cm. In 10% of the patients, shortening after surgery of 1.7 ± 1.4 mm (0.3–3.1 mm) occurred. One child initially treated with traction therapy showed skin irritations and was operated with ESIN. No non-union or ESIN-related complications were found. Mean follow-up was 5.1 ± 4.4 months (4–24 months). First independent mobilization was seen at an average of 3.4 ± 1.1 weeks (2–6 weeks) after surgery. Implant removal was performed after 3.2 ± 1.3 months (2–8 months). No refracture after implant removal occurred. CONCLUSION: Early results with ESIN show a reasonable and safe treatment option for femur fractures in toddlers and young children under the age of 3 with easy postoperative care, fast fracture union and early independent mobilization.
format Online
Article
Text
id pubmed-9532282
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Springer Berlin Heidelberg
record_format MEDLINE/PubMed
spelling pubmed-95322822022-10-06 ESIN in femur fractures in children under 3: is it safe? Cintean, Raffael Eickhoff, Alexander Pankratz, Carlos Strauss, Beatrice Gebhard, Florian Schütze, Konrad Eur J Trauma Emerg Surg Original Article BACKGROUND: Pediatric femur fractures are a major trauma in children. Different treatment algorithms have been developed but indications for surgical treatment, especially in very young patients, are still controversial. Literature recommends surgical stabilization with elastic-stable intramedullary nailing (ESIN) starting at the age of 3 and non-operative treatment in younger patients. This study sought to present the outcome of patients younger than 3 years of age treated with ESIN for femur fractures. MATERIALS AND METHODS: Inclusion criteria were patients younger than 3 treated with ESIN in femur fractures. Patient demographics, fracture characteristics, mechanism of injury, outcomes and complications were recorded using charts and X-rays. Primary outcome measures were time to mobility, fracture consolidation and surgical-related complications. RESULTS: Between 2010 and 2020, 159 patients were treated with ESIN in femur fractures in our institution. A total of 30 patients met the criteria. The mean age was 2.1 ± 0.7 years (13 months–2.9 years). Most common mechanism was fall from standing height (60%). Other mechanisms were motor vehicle accidents as a pedestrian (10%) or as a passenger (10%) as well as direct blow trauma (20%). Femoral shaft fracture was the most common injury (80%). 5 subtrochanteric and one distal metaphyseal femur fractures were found. Mean length of stay was 2.0 ± 1.3 days. Radiographic controls were performed on day 1, 14 and 6 weeks after surgery if not otherwise specified or if complications occurred. 4.6 ± 1.2 (n 2–7) X-rays were performed on average after surgery. First radiographic consolidation signs were seen after 2.4 ± 0.6 weeks. Only one child showed surgical-related complication with a leg length discrepancy of 1 cm. In 10% of the patients, shortening after surgery of 1.7 ± 1.4 mm (0.3–3.1 mm) occurred. One child initially treated with traction therapy showed skin irritations and was operated with ESIN. No non-union or ESIN-related complications were found. Mean follow-up was 5.1 ± 4.4 months (4–24 months). First independent mobilization was seen at an average of 3.4 ± 1.1 weeks (2–6 weeks) after surgery. Implant removal was performed after 3.2 ± 1.3 months (2–8 months). No refracture after implant removal occurred. CONCLUSION: Early results with ESIN show a reasonable and safe treatment option for femur fractures in toddlers and young children under the age of 3 with easy postoperative care, fast fracture union and early independent mobilization. Springer Berlin Heidelberg 2022-04-08 2022 /pmc/articles/PMC9532282/ /pubmed/35394142 http://dx.doi.org/10.1007/s00068-022-01965-4 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Cintean, Raffael
Eickhoff, Alexander
Pankratz, Carlos
Strauss, Beatrice
Gebhard, Florian
Schütze, Konrad
ESIN in femur fractures in children under 3: is it safe?
title ESIN in femur fractures in children under 3: is it safe?
title_full ESIN in femur fractures in children under 3: is it safe?
title_fullStr ESIN in femur fractures in children under 3: is it safe?
title_full_unstemmed ESIN in femur fractures in children under 3: is it safe?
title_short ESIN in femur fractures in children under 3: is it safe?
title_sort esin in femur fractures in children under 3: is it safe?
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9532282/
https://www.ncbi.nlm.nih.gov/pubmed/35394142
http://dx.doi.org/10.1007/s00068-022-01965-4
work_keys_str_mv AT cinteanraffael esininfemurfracturesinchildrenunder3isitsafe
AT eickhoffalexander esininfemurfracturesinchildrenunder3isitsafe
AT pankratzcarlos esininfemurfracturesinchildrenunder3isitsafe
AT straussbeatrice esininfemurfracturesinchildrenunder3isitsafe
AT gebhardflorian esininfemurfracturesinchildrenunder3isitsafe
AT schutzekonrad esininfemurfracturesinchildrenunder3isitsafe