Berger P, De Graaf J S, Leemans R
Medical Hospital Leeuwarden, Department of Surgery, Henri Dunantweg 2, Postbus 888, 8901 BR Leeuwarden, The Netherlands.
Injury. 2005 Oct;36(10):1217-20. doi: 10.1016/j.injury.2005.05.012.
The treatment of paediatric long-bone fractures remains controversial. Elastic intramedullary nailing has been proposed as an alternative for the treatment of paediatric long-bone fractures.
We treated 68 children in a time span of 9 years with 32 fractures of the forearm, 27 fractures of the femur and nine fractures of the tibia. The mean age was 8.3 years and the mean admission time 2.6 days.
Mean consolidation time was 7.9 weeks for the forearm fractures, 11.9 weeks for the femur fractures and 10.6 weeks for the tibial fractures. Full weight bearing for the latter two fracture types was allowed within the first week. There were no major complications. The complications encountered were three hydrops of the knee, four low-grade infections and one delayed union. Leg length discrepancy was only seen in five patients (18%) and was less than 2 cm.
In femur fractures, we let the parents decide between skeletal traction and intramedullary rods. When confronted with the possible complications (operation-related complications and infection) compared to the advantages (early weight bearing and short admission time), they almost always choose the operative approach. In our opinion, elastic intramedullary nailing is an excellent treatment option for diaphyseal fractures in children with skeletal immaturity, especially of the femur.
小儿长骨骨折的治疗仍存在争议。弹性髓内钉已被提议作为小儿长骨骨折治疗的一种替代方法。
我们在9年的时间里治疗了68名儿童，其中前臂骨折32例，股骨骨折27例，胫骨骨折9例。平均年龄为8.3岁，平均入院时间为2.6天。
前臂骨折的平均愈合时间为7.9周，股骨骨折为11.9周，胫骨骨折为10.6周。后两种骨折类型在第一周内即可完全负重。无重大并发症。所遇到的并发症为3例膝关节积液、4例轻度感染和1例延迟愈合。仅5例患者（18%）出现腿长差异，且差异小于2厘米。
对于股骨骨折，我们让家长在骨骼牵引和髓内钉之间做出选择。当与优点（早期负重和短入院时间）相比面临可能的并发症（手术相关并发症和感染）时，他们几乎总是选择手术方法。我们认为，弹性髓内钉是治疗骨骼未成熟儿童骨干骨折的极佳选择，尤其是股骨骨折。
