Milligan D, Henderson L, Tucker A, Ballard J
C/O Fracture Clinic, Royal Belfast Hospital for Sick Children, Falls Road, Belfast, Northern Ireland, BT12 6BE, UK.
Royal Belfast Hospital for Sick Children, Falls Road, Belfast, Northern Ireland, BT12 6BE, UK.
J Orthop. 2019 Nov 27;19:153-157. doi: 10.1016/j.jor.2019.11.033. eCollection 2020 May-Jun.
The management of paediatric femoral fractures continues to spark debate in published literature, with poor quality evidence guiding current guidelines on the optimum treatment in children. Many centres report excellent results for both elastic intramedullary nailing and plate fixation of diaphyseal femoral fractures. This study aimed to investigate the outcomes of femoral fractures treated with elastic nail fixation versus those treated with plate fixation in a tertiary children's trauma unit, and discuss the advantages and disadvantages of each technique.
A retrospective review of all femoral fractures undergoing fixation at a level one paeditric trauma and tertiary referral unit, between 1 April 2009 and 30 April 2017, was performed.Clinical notes and radiographs were reviewed to determine patient demographics and injury, operative and hospital stay data. Radiological union, defined as bridging callus present on at least three out of four cortices on orthogonal radiographs, was determined at 12 weeks. Outcomes were determined using the Flynn Criteria. Patients were followed up for a minimum of 2 years. Data was statistically analysed, and a p value < 0.05 was considered significant.
There were a total of 28 patients- 14 in each treatment group. Patients undergoing elastic nail fixation were significantly older than plate fixation (9.7 ± 1.9 Vs 7.7 ± 1.8; p = 0.008). A male preponderance was noted (21/28), with no difference between groups (10 Vs 11; p = 1.00). Plate fixation demonstrated a tendency towards shorter length of stay (6.3 ± 2.1 Vs 7.8 ± 3.0; p = 0.134), earlier radiological union at 12 weeks (14 Vs 10; p = 0.098), lower postoperative analgesia requirements (0.82 ± 0.45 Vs 1.12 ± 0.97; p = 0.200), and better outcomes, as determined by the Flynn criteria.
In the authors opinion, plate fixation is a safe, effective alternative to elastic nail fixation with equivocal outcomes as determined by the Flynn Criteria. Plate fixation may offer advantages in shorter length of stay, reduced postoperative pain and earlier weightbearing. Further large scale, prospective research is required to determine whether these are borne out in practice.
小儿股骨干骨折的治疗方法在已发表的文献中仍存在争议，目前关于儿童最佳治疗方案的指南所依据的证据质量不高。许多中心报告称，弹性髓内钉固定和股骨干骨折钢板固定均取得了良好效果。本研究旨在调查在一家三级儿童创伤中心，弹性髓内钉固定与钢板固定治疗股骨干骨折的疗效，并探讨每种技术的优缺点。
对2009年4月1日至2017年4月30日期间在一家一级儿童创伤和三级转诊单位接受骨折固定术的所有股骨干骨折病例进行回顾性研究。查阅临床记录和X光片，以确定患者的人口统计学资料和损伤情况、手术及住院时间数据。在术后12周通过X光片确定影像学愈合情况，即正交X光片上至少四个皮质中有三个出现骨痂桥接。使用弗林标准确定治疗效果。对患者进行至少2年的随访。对数据进行统计学分析，p值<0.05被认为具有统计学意义。
共有28例患者，每组各14例。接受弹性髓内钉固定的患者年龄显著大于接受钢板固定的患者（9.7±1.9岁对7.7±1.8岁；p=0.008）。男性患者居多（21/28），两组之间无差异（1男10女对1男11女；p=1.00）。钢板固定组住院时间有缩短趋势（6.3±2.1天对7.8±3.0天；p=0.134），术后12周影像学愈合更早（14例对10例；p=0.098），术后镇痛需求更低（0.82±0.45对1.12±0.97；p=0.200），且根据弗林标准，治疗效果更好。
作者认为，根据弗林标准，钢板固定是弹性髓内钉固定的一种安全、有效的替代方法，二者疗效相当。钢板固定在缩短住院时间、减轻术后疼痛以及更早负重方面可能具有优势。需要进一步开展大规模的前瞻性研究，以确定这些优势在实际应用中是否成立。
