Trauma: Complications of Femoral Diaphyseal Fractures

Yavuz SAĞLAMa , Avni İlhan BAYHANb

aİstanbul University İstanbul Faculty of Medicine, Department of Orthopedics and Traumatology, İstanbul, Türkiye
bMetin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Türkiye

ABSTRACT
The ideal choice of treatment for femoral diaphysis fractures in pediatric patients has remained a constant challenge for pediatric orthopedic surgeons and pose a management dilemma, particularly in school-aged children. The available literature does point to a number of trends, however, which have emerged to aid in decision-making regarding management in select circumstances. A lack of comparative evidence investigating best practices has limited the applicability of conscientious attempts at the creation of formal management guidelines. Multiple fixation modalities are available such as, conventional plating, biologic plating, titanium elastic nailing, external fixation and rigid nailing. Management decisions are primarily based on the age and size of the patient. Other important considerations include fracture configuration, surgeon’s experience and disruption to family life. All these modalities have different type and rate of complications, which will be discussed in individual sections.
Keywords: Femoral fractures; femur; complication

Referanslar

  1. May C, Yen YM, Nasreddine AY, Hedequist D, Hresko MT, Heyworth BE. Complications of plate fixation of femoral shaft fractures in children and adolescents. J Child Orthop. 2013;7(3):235-43. [Crossref]  [PubMed]  [PMC]
  2. Kocher MS, Sink EL, Blasier RD, Luhmann SJ, Mehlman CT, Scher DM, et al. Treatment of pediatric diaphyseal femur fractures. J Am Acad Orthop Surg. 2009;17(11):718-25. [Crossref]  [PubMed]
  3. Beaty JH, Kasser JR. Rockwood & Wilkins' Fractures in children. 6th ed. Baltimore: Lippincott Williams & Wilkins; 2006.
  4. Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J. Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications. J Pediatr Orthop. 2001;21(1):4-8. [Crossref]  [PubMed]
  5. Ağuş H, Kalenderer O, Eryanilmaz G, Omeroğlu H. Biological internal fixation of comminuted femur shaft fractures by bridge plating in children. J Pediatr Orthop. 2003;23(2):184-9. [Crossref]  [PubMed]
  6. Flynn JM, Luedtke L, Ganley TJ, Pill SG. Titanium elastic nails for pediatric femur fractures: lessons from the learning curve. Am J Orthop (Belle Mead NJ). 2002;31(2):71-4.
  7. Flynn JM, Garner MR, Jones KJ, D'Italia J, Davidson RS, Ganley TJ, et al. The treatment of low-energy femoral shaft fractures: a prospective study comparing the "walking spica" with the traditional spica cast. J Bone Joint Surg Am. 2011;93(23):2196-202. [Crossref]  [PubMed]
  8. Tisherman RT, Hoellwarth JS, Mendelson SA. Systematic review of spica casting for the treatment of paediatric diaphyseal femur fractures. J Child Orthop. 2018;12(2):136-44. [Crossref]  [PubMed]  [PMC]
  9. Nordin S, Ros MD, Faisham WI. Clinical measurement of longitudinal femoral overgrowth following fracture in children. Singapore Med J. 2001;42(12):563-5.
  10. Gross I, Hashavya S, Rogachev S, Simanovsky N, Shrabaty T, Zaidman M, et al. Orthotic hip brace as an alternative for treatment of femoral fractures in children under the age of 3 years: a retrospective study. J Pediatr Orthop B. 2023;32(3):287-91. [Crossref]  [PubMed]
  11. Chen W, Li J, Zhang YZ. [Interpretation of American Academy of Orthopaedic Surgeons Clinical Practice Guideline on the Treatment of Pediatric Diaphyseal Femur Fractures]. Zhonghua Wai Ke Za Zhi. 2017;55(1):44-8. Chinese. [Crossref]
  12. Rush JK, Kelly DM, Sawyer JR, Beaty JH, Warner WC Jr. Treatment of pediatric femur fractures with the Pavlik harness: multiyear clinical and radiographic outcomes. J Pediatr Orthop. 2013;33(6):614-7. [Crossref]  [PubMed]
  13. Mahajan J, Hennrikus W, Piazza B. Overgrowth after femoral shaft fractures in infants treated with a Pavlik harness. J Pediatr Orthop B. 2016;25(1):7-10. [Crossref]  [PubMed]
  14. Sanders JO, Browne RH, Mooney JF, Raney EM, Horn BD, Anderson DJ, et al. Treatment of femoral fractures in children by pediatric orthopedists: results of a 1998 survey. J Pediatr Orthop. 2001;21(4):436-41. [Crossref]  [PubMed]
  15. Younis MH, Mahmoud K, Kawas A, Ibrahim T. Early versus late hip spica casting for paediatric femoral shaft fractures. J Pediatr Orthop B. 2019;28(2):122-6. [Crossref]  [PubMed]
  16. Trottier ÉR, Hatcher L, Feng J, Camp M, Bouchard M. Incidence of secondary interventions after early spica casting for diaphyseal femur fractures in young children. Can J Surg. 2022;65(4):E417-E24. [Crossref]  [PubMed]  [PMC]
  17. Dietzel M, Schöneberg LO, Schunn M, Scherer S, Esser M, Kirschner HJ, et al. Results after skin traction for femur shaft fractures in children below the age of four years. Eur J Trauma Emerg Surg. 2022;48(5):3393-9. [Crossref]  [PubMed]  [PMC]
  18. Leu D, Sargent MC, Ain MC, Leet AI, Tis JE, Sponseller PD. Spica casting for pediatric femoral fractures: a prospective, randomized controlled study of single-leg versus double-leg spica casts. J Bone Joint Surg Am. 2012;94(14):1259-64. [Crossref]  [PubMed]
  19. Mubarak SJ, Frick S, Sink E, Rathjen K, Noonan KJ. Volkmann contracture and compartment syndromes after femur fractures in children treated with 90/90 spica casts. J Pediatr Orthop. 2006;26(5):567-72. [Crossref]  [PubMed]
  20. Chen SH, Chen WS, Chuang JH. Superior mesenteric artery syndrome as a complication in hip spica application for immobilization: report of a case. J Formos Med Assoc. 1992;91(7):731-3.
  21. Caird MS, Mueller KA, Puryear A, Farley FA. Compression plating of pediatric femoral shaft fractures. J Pediatr Orthop. 2003 23(4):448-52. [Crossref]  [PubMed]
  22. Kanlic EM, Anglen JO, Smith DG, Morgan SJ, Pesántez RF. Advantages of submuscular bridge plating for complex pediatric femur fractures. Clin Orthop Relat Res. 2004;(426):244-51. [Crossref]  [PubMed]
  23. Sink EL, Faro F, Polousky J, Flynn K, Gralla J. Decreased complications of pediatric femur fractures with a change in management. J Pediatr Orthop. 2010;30(7):633-7. [Crossref]  [PubMed]
  24. Sink EL, Gralla J, Repine M. Complications of pediatric femur fractures treated with titanium elastic nails: a comparison of fracture types. J Pediatr Orthop. 2005;25(5):577-80. [Crossref]  [PubMed]
  25. Duffy S, Gelfer Y, Trompeter A, Clarke A, Monsell F. The clinical features, management options and complications of paediatric femoral fractures. Eur J Orthop Surg Traumatol. 2021;31(5):883-92. Erratum in: Eur J Orthop Surg Traumatol. 2021. [Crossref]  [PubMed]  [PMC]
  26. Moroz LA, Launay F, Kocher MS, Newton PO, Frick SL, Sponseller PD, et al. Titanium elastic nailing of fractures of the femur in children. Predictors of complications and poor outcome. J Bone Joint Surg Br. 2006;88(10):1361-6. [Crossref]  [PubMed]
  27. Bar-On E, Sagiv S, Porat S. External fixation or flexible intramedullary nailing for femoral shaft fractures in children. A prospective, randomised study. J Bone Joint Surg Br. 1997;79(6):975-8. Erratum in: J Bone Joint Surg Br 1998;80(4):749. [Crossref]  [PubMed]
  28. Hosalkar HS, Pandya NK, Cho RH, Glaser DA, Moor MA, Herman MJ. Intramedullary nailing of pediatric femoral shaft fracture. J Am Acad Orthop Surg. 2011;19(8):472-81. [Crossref]  [PubMed]
  29. Keeler KA, Dart B, Luhmann SJ, Schoenecker PL, Ortman MR, Dobbs MB, et al. Antegrade intramedullary nailing of pediatric femoral fractures using an interlocking pediatric femoral nail and a lateral trochanteric entry point. J Pediatr Orthop. 2009;29(4):345-51. [Crossref]  [PubMed]
  30. MacNeil JA, Francis A, El-Hawary R. A systematic review of rigid, locked, intramedullary nail insertion sites and avascular necrosis of the femoral head in the skeletally immature. J Pediatr Orthop. 2011;31(4):377-80. [Crossref]  [PubMed]
  31. Kim JW, Oh JK, Byun YS, Shon OJ, Park JH, Oh HK, et al. Incidence of Avascular Necrosis of the Femoral Head After Intramedullary Nailing of Femoral Shaft Fractures: A Multicenter Retrospective Analysis of 542 Cases. Medicine (Baltimore). 2016;95(5):e2728. [Crossref]  [PubMed]  [PMC]