Naranje Sameer M, Stewart Matthew G, Kelly Derek M, Jones Tamekia L, Spence David D, Warner William C, Beaty James H, Sawyer Jeffrey R
*Forrest City Medical Center, Forrest City, AR †Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee ‡Department of Orthopaedics, Le Bonheur Children's Hospital §Department of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN.
J Pediatr Orthop. 2016 Oct-Nov;36(7):e81-5. doi: 10.1097/BPO.0000000000000633.
The options for treating femoral fractures in children and adolescents have evolved over the last 2 decades to include a variety of nonoperative and operative methods. The purpose of this study was to identify changes in the types of treatment for pediatric femoral fractures in the United States from 1997 to 2012.
From discharge estimates for 1997, 2000, 2003, 2006, 2009, and 2012 in the Kids' Inpatient Database, data were extracted using the International Classification of Diseases, 9th revision, and Clinical Modification for pediatric femoral fracture treatments. Patients included were 0 to 17 years old and were categorized into 5 age groups: younger than 1, 1 to 4, 5 to 9, 10 to 14, and 15 to 17 years.
A total of 74,483 estimated discharges were recorded for pediatric patients with femoral fractures in the database for years 1997, 2000, 2003, 2006, 2009, and 2012. A total of 12,986 pediatric femoral fractures were estimated for 1997 and 9813 for 2012, which was statistically different (P<0.0001). Significantly fewer fractures were treated with closed reduction alone in 2012 than in 1997 in age groups 5 to 9, 10 to 14, and 15 to 17 years. Children aged 5 to 9 had more frequent open reduction and internal fixation in 2012 than in 1997, whereas adolescents aged 15 to 17 had less frequent open reduction and internal fixation in 2012 than in 1997.
Although the number of femoral shaft fractures overall has decreased, the frequency of operative treatment has increased significantly in patients 5 to 9 years of age. Knowledge of these trends can guide educational efforts and resource allocation, but further study is necessary to determine procedure-specific (eg, nailing, plating, external fixation) trends and their clinical and economic impacts.
Level III-case series.
在过去20年中，儿童和青少年股骨骨折的治疗选择不断演变，包括多种非手术和手术方法。本研究的目的是确定1997年至2012年美国儿童股骨骨折治疗类型的变化。
从儿童住院数据库中提取1997年、2000年、2003年、2006年、2009年和2012年的出院估计数据，使用国际疾病分类第九版及临床修订版对儿童股骨骨折治疗进行数据提取。纳入的患者年龄在0至17岁之间，分为5个年龄组：小于1岁、1至4岁、5至9岁、10至14岁和15至17岁。
在1997年、2000年、2003年、2006年、2009年和2012年的数据库中，共记录了74483例儿童股骨骨折患者的估计出院病例。1997年估计有12986例儿童股骨骨折，2012年为9813例，差异有统计学意义（P<0.0001）。2012年，5至9岁、10至14岁和15至17岁年龄组中单纯闭合复位治疗的骨折明显少于1997年。2012年，5至9岁儿童切开复位内固定的频率高于1997年，而15至17岁青少年切开复位内固定的频率低于1997年。
尽管股骨干骨折的总数有所减少，但5至9岁患者的手术治疗频率显著增加。了解这些趋势可为教育工作和资源分配提供指导，但有必要进一步研究以确定特定手术（如髓内钉固定、钢板固定、外固定）的趋势及其临床和经济影响。
三级病例系列。
