Wilson Nichola C, Stott N Susan
Department of Orthopaedics, Palmerston North Hospital, Palmerston North, New Zealand.
Injury. 2007 Aug;38(8):931-6. doi: 10.1016/j.injury.2007.03.013. Epub 2007 Jun 15.
This report describes factors influencing length of stay and unplanned readmissions within 30 days of discharge for children presenting with femoral fractures to Starship Hospital.
The charts and radiographs of all children admitted with femoral shaft fractures between January 1998 and December 2002 were reviewed, excluding pathological fractures. The type of management, the length of stay and the unexpected readmission rate within 30 days were recorded. Ninety-three children with 95 femoral fractures were included in the study.
Forty-six fractures were treated by application of immediate hip spica and 49 by other surgical methods (21 by external fixation, 20 by flexible intramedullary nailing and 8 by other methods). Patients with isolated femur fractures treated by either hip spica application or other operative fixation had median lengths of stay of 3 days (range 1-10 days) and 6 days (range 2-15 days), respectively. Patients with associated injuries, whose femur fractures were treated by either hip spica application or other operative fixation, had longer median lengths of stay of 5 days (3-15 days) and 17 days (5-70 days), respectively. Nine of the 93 children had an unplanned return to the operating theatre during their initial hospital stay, with increased length of stay in 5 as a result. A further 21 children were readmitted within 30 days of discharge with problems of loss of fracture alignment and cast damage in the hip spica group; pin-site infections in the external fixation group and pain around the distal nail insertion site in the flexible intramedullary nailing group. Despite these early problems, fracture alignment was satisfactory at union in 89 of the 95 fractures, with satisfactory remodelling in the remaining six fractures at follow-up.
The presence of associated injuries was a key factor in the length of the initial hospital stay. However, the need for further operative interventions in the first hospital stay also increased the length of stay in some patients. Overall, the operative management of femoral fractures is resource intensive with a significant need for further minor operative intervention, regardless of the type of initial management.
本报告描述了影响星舰医院收治的股骨骨折患儿住院时间及出院后30天内非计划再入院的因素。
回顾了1998年1月至2002年12月期间所有因股骨干骨折入院的儿童的病历和X光片，排除病理性骨折。记录治疗方式、住院时间及30天内的意外再入院率。93例患儿共95处股骨骨折纳入本研究。
46处骨折采用即时髋人字石膏固定治疗，49处采用其他手术方法治疗（21处采用外固定，20处采用弹性髓内钉固定，8处采用其他方法）。单纯股骨骨折采用髋人字石膏固定或其他手术固定治疗的患者，中位住院时间分别为3天（1 - 10天）和6天（2 - 15天）。伴有其他损伤且股骨骨折采用髋人字石膏固定或其他手术固定治疗的患者，中位住院时间分别更长，为5天（3 - 15天）和17天（5 - 70天）。93例患儿中有9例在首次住院期间非计划返回手术室，其中5例因此延长了住院时间。另外21例患儿在出院后30天内再次入院，髋人字石膏固定组出现骨折对位丢失和石膏损坏问题；外固定组出现针道感染；弹性髓内钉固定组出现远端钉插入部位周围疼痛。尽管有这些早期问题，但95处骨折中有89处骨折愈合时对位良好，其余6处骨折随访时重塑良好。
伴有其他损伤是首次住院时间长短的关键因素。然而，首次住院期间需要进一步手术干预也增加了部分患者的住院时间。总体而言，股骨骨折的手术治疗资源消耗大，无论初始治疗方式如何，都非常需要进一步的小型手术干预。
