Ramseier Leonhard Erich, Bhaskar Atul R, Cole William G, Howard Andrew W
Division of Orthopaedics, Hospital for Sick Children, Toronto, Canada.
J Pediatr Orthop. 2007 Oct-Nov;27(7):748-50. doi: 10.1097/BPO.0b013e3181558b00.
Open femur fractures in children are uncommon and usually associated with other injuries. In adults, there is a current trend to treat open fractures with intramedullary (IM) devices. The goal of this study was to compare external fixator (EF) to IM devices in the treatment of open femur fractures in children.
Diaphyseal femur fractures without growth plate involvement were included. Thirty-five patients (12 IM; 23 EF) were identified. Age, hospital stay, polytrauma, mechanism of injury, and Gustilo-Anderson grade were recorded. Follow-up was at least until the fracture was clinically and radiographically healed.
Patients with EFs were 5.2 times more likely (95% confidence interval, 1.05-25.5) to have any complication. Excluding pin track infections, patients with EFs were 2.7 times as likely (95% confidence interval, 0.567-13.2) to have a complication. Refractures occurred only in the EF group (6/23, 26%) and not in the IM nailing group (P = 0.062, Fischer exact test). These were associated with varus malunions-all 3 of the EF group with more than 15 degrees of varus at fracture union suffered a refracture.
Treatment of open femur fractures in children is a challenging problem. Treatment with IM devices had fewer complications than the EF. We think that whenever possible, the use of IM devices for the treatment of open femur fracture in children should be considered, especially grade 1 open injuries. If EFs are used, avoiding varus malunion may decrease the refracture rate, and secondary change to an IM device should be considered.
Comparative cohort study. Grade 3 level of evidence.
儿童开放性股骨骨折并不常见，通常还伴有其他损伤。在成人中，目前有一种使用髓内（IM）装置治疗开放性骨折的趋势。本研究的目的是比较外固定器（EF）与IM装置在治疗儿童开放性股骨骨折中的效果。
纳入不涉及生长板的股骨干骨折患者。共确定了35例患者（12例使用IM装置；23例使用EF）。记录患者的年龄、住院时间、多发伤情况、损伤机制和 Gustilo-Anderson 分级。随访至少持续到骨折临床和影像学愈合。
使用EF的患者发生任何并发症的可能性是使用IM装置患者的5.2倍（95%置信区间，1.05 - 25.5）。排除针道感染后，使用EF的患者发生并发症的可能性是使用IM装置患者的2.7倍（95%置信区间，0.567 - 13.2）。再骨折仅发生在EF组（6/23，26%），而IM钉固定组未发生（P = 0.062，Fisher确切概率检验）。这些再骨折与内翻畸形愈合相关——EF组中骨折愈合时内翻超过15度的所有3例患者均发生了再骨折。
儿童开放性股骨骨折的治疗是一个具有挑战性的问题。使用IM装置治疗的并发症比使用EF少。我们认为，只要有可能，就应考虑使用IM装置治疗儿童开放性股骨骨折，尤其是1级开放性损伤。如果使用EF，避免内翻畸形愈合可能会降低再骨折率，并且应考虑二次更换为IM装置。
比较队列研究。证据等级为3级。
