Kong Heather, Sabharwal Sanjeev
Department of Orthopaedic Surgery, Rutgers University-New Jersey Medical School, Doctor's Office Center, 90 Bergen Street Suite 7300, Newark, NJ, 07103, USA,
Clin Orthop Relat Res. 2014 Dec;472(12):3814-22. doi: 10.1007/s11999-014-3554-5.
Recent advances in external fixation technique and pin design have sought to minimize complications such as pin site infection and premature removal of the external fixator. Although newer forms of internal fixation have gained popularity, external fixation may still have a role in managing pediatric femoral shaft fractures.
QUESTIONS/PURPOSES: We sought to assess the time to healing, limb alignment, and complications observed in a cohort of pediatric patients with closed femoral shaft fractures who were treated with external fixation.
Over a 15-year period, one surgeon treated 289 pediatric patients with femur fractures, 31 (11%) of whom received an external fixator. The general indications for use of an external fixator during the period in question included length-unstable fractures, metadiaphyseal location, refracture, and pathologic fracture. Six patients (19%) had inadequate followup data and four patients (13%) were treated with a combination of flexible intramedullary nails and external fixation, leaving 21 patients for analysis. Mean age at injury was 10 years (range, 6-15 years) and followup averaged 22 months (range, 5-45 months) after removal of the fixator. Radiographs were examined for alignment and limb length discrepancy. Complications were recorded from a chart review.
Mean time in the fixator was 17 weeks (range, 9-24 weeks). One patient sustained a refracture and one patient with an isolated femur fracture had a leg length discrepancy > 2 cm. There were no pin site infections requiring intravenous antibiotics or additional surgery. One patient with Blount disease and previous tibial osteotomy developed transient peroneal nerve palsy.
Despite improvements in pin design and predictable fracture healing, complications such as refracture and leg length discrepancy after external fixation of pediatric femoral shaft fractures can occur. However, external fixation remains a viable alternative for certain fractures such as length-unstable fractures, metadiaphyseal location, pathologic fractures, and refractures.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
外固定技术和钢针设计的最新进展旨在尽量减少诸如针道感染和外固定器过早拆除等并发症。尽管新型内固定方式已更受欢迎，但外固定在小儿股骨干骨折的治疗中仍可能发挥作用。
问题/目的：我们试图评估一组接受外固定治疗的闭合性股骨干骨折小儿患者的愈合时间、肢体对线情况及观察到的并发症。
在15年期间，一名外科医生治疗了289例股骨骨折小儿患者，其中31例（11%）接受了外固定器治疗。在此期间使用外固定器的一般指征包括长度不稳定骨折、干骺端骨折、再骨折和病理性骨折。6例患者（19%）随访数据不完整，4例患者（13%）接受了弹性髓内钉与外固定联合治疗，最终有21例患者可供分析。受伤时的平均年龄为10岁（范围6 - 15岁），拆除固定器后平均随访22个月（范围5 - 45个月）。检查X线片以评估对线和肢体长度差异。通过查阅病历记录并发症情况。
固定器平均使用时间为17周（范围9 - 24周）。1例患者发生再骨折，1例单纯股骨骨折患者的腿长差异>2 cm。没有需要静脉使用抗生素或再次手术的针道感染。1例患有Blount病且既往有胫骨截骨术的患者出现了短暂性腓总神经麻痹。
尽管钢针设计有所改进且骨折愈合可预测，但小儿股骨干骨折外固定后仍可能发生再骨折和腿长差异等并发症。然而，对于某些骨折，如长度不稳定骨折、干骺端骨折、病理性骨折和再骨折，外固定仍然是一种可行的选择。
IV级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
