Dey Sukalyan, Mishra Kartikey, Nagda Taral Vishanji, Dhamele Jaideep, Rathod Chasanal, Dey Dipa
Department of Orthopaedics, Gauhati Medical College and Hospital, Guwahati, Assam, India.
Institute of Paediatric Orthopaedic Disorders, Mumbai, Maharashtra, India.
Indian J Orthop. 2018 Sep-Oct;52(5):507-512. doi: 10.4103/ortho.IJOrtho_304_17.
High-velocity trauma, associated injuries, risk of iatrogenic devascularization of fragments and need for maintaining alignment upto union make comminuted fracture in pediatric femur a formidable fracture to treat. This comparative study was conducted to evaluate the outcomes of two modes of management in such cases: titanium elastic nailing supplemented with external fixator and submuscular bridge plating (BP).
Thirty eight children (aged 6-12 years) with comminuted fracture shaft femur who were randomized into two groups underwent systematic evaluation. One group was operated with titanium nailing with temporary external stabilization by fixators (titanium nailing with external [TNE] group) for 4 weeks. The other underwent submuscular BP with locked plates (BP group). Clinical and radiological outcomes, operative time, blood loss, radiation exposure, difficulties in removal and complications were evaluated.
Both groups achieved union (10.7 ± 1.9 weeks BP, 11 ± 1.6 weeks TNE), satisfactory knee flexion (138.2 ± 6.4° BP, 136 ± 7.3° TNE), and painless weight bearing (7.3 ± 0.9 weeks vs. 7.3 ± 1.4 weeks) in acceptable alignment. Functional outcomes were excellent in majority of both BP (15 of 19) and nail external fixator groups (15 of 18). Operating time and radiation exposure (69.5 ± 14.5 s vs. 50.9 ± 12.9 s) were more in TNE than in BP ( < 0.01). However, implant removal was more difficult in BP (56.4 ± 12.4 min in BP vs. 30.1 ± 8.8 min TNE). Pin-tract infections ( = 3) and hardware prominence ( = 2) in TNE group and deep infections ( = 2) in BP group were notable complications.
Two groups were similar in radiological and functional outcomes. Inserting elastic nails and external fixator was a more exacting surgery, while removal was more difficult in BP group. Both techniques had acceptable success and complication rates.
高速创伤、合并伤、骨折碎片医源性血管化风险以及直至骨折愈合维持对线的需求，使得小儿股骨干粉碎性骨折成为一种难以治疗的骨折。本比较研究旨在评估此类病例两种治疗方式的疗效：钛弹性髓内钉联合外固定器及肌下桥接钢板固定（BP）。
38例6至12岁股骨干粉碎性骨折患儿被随机分为两组并接受系统评估。一组采用钛钉内固定并临时用外固定器稳定（钛钉联合外固定[TNE]组）4周。另一组采用带锁定钢板的肌下BP固定（BP组）。对临床和影像学结果、手术时间、失血量、辐射暴露、取出困难程度及并发症进行评估。
两组均实现骨折愈合（BP组10.7±1.9周，TNE组11±1.6周），膝关节屈曲满意（BP组138.2±6.4°，TNE组136±7.3°），且在可接受对线情况下无痛负重（分别为7.3±0.9周和7.3±1.4周）。BP组（19例中的15例）和髓内钉联合外固定器组（18例中的15例）大多数患儿功能结果良好。TNE组的手术时间和辐射暴露（69.5±14.5秒对50.9±12.9秒）均多于BP组（P<0.01）。然而，BP组的植入物取出更困难（BP组56.4±12.4分钟，TNE组30.1±8.8分钟）。TNE组的针道感染（3例）和内植物突出（2例）以及BP组的深部感染（2例）为显著并发症。
两组在影像学和功能结果方面相似。插入弹性髓内钉和外固定器手术要求更高，而BP组的取出更困难。两种技术均有可接受的成功率和并发症发生率。
