Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH.
Orthopaedic Department, Second State Central Hospital, Mongolian National Diagnostic and Treatment Center, Ulaanbaatar, Mongolia ; and.
J Orthop Trauma. 2021 Nov 1;35(11):e405-e410. doi: 10.1097/BOT.0000000000002076.
To evaluate femoral growth after placement of retrograde intramedullary nails in the treatment of pediatric femoral shaft fractures.
Retrospective case series.
Large urban trauma center in Mongolia.
PATIENTS/PARTICIPANTS: Twenty-nine pediatric patients who sustained a diaphyseal femoral shaft fracture were included in the study.
Retrograde intramedullary nail fixation with the standard, fin, or pediatric fin Surgical Implant Generation Network nail across an open distal femoral physis.
The main outcome measure was the distance traveled by the intramedullary nail with respect to the distal femoral condyles and distal femoral physis from initial surgery to follow-up.
The mean age of patients was 10.7 years (range: 7-14 years). Follow-up occurred at a mean of 292 days (range: 53-714 days). Both condyle distance and physis distance were significantly positively correlated with follow-up days, with Pearson R values of 0.90 (P < 0.001) and 0.84 (P < 0.001), respectively. Multiple regression analysis revealed that follow-up days was the only significant predictor of physis distance, whereas age, sex, percent growth plate violation, and nail fully traversing physis were not significant predictors. The nail completely crossed the physis in 5 patients and no growth arrests were found.
This is the first study, to our knowledge, to evaluate treating femoral shaft fractures with a retrograde nail across an open distal femoral physis. In the pediatric population, the use of a retrograde femoral intramedullary nails does not seem to cause growth arrest of the injured femur during the postoperative period and may be a reasonable treatment option when other surgical options are not available. Additional study is necessary to further evaluate the safety profile.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
评估逆行髓内钉治疗儿童股骨干骨折后股骨的生长情况。
回顾性病例系列研究。
蒙古的一个大型城市创伤中心。
患者/参与者：本研究纳入了 29 例儿童股骨干骨折患者。
经开放的股骨远端骺板行逆行髓内钉固定，使用标准、细或儿童细 Surgical Implant Generation Network 钉。
主要观察指标为从初始手术到随访时，髓内钉相对于股骨远端髁和股骨远端骺板的移动距离。
患者的平均年龄为 10.7 岁（范围：7-14 岁）。平均随访时间为 292 天（范围：53-714 天）。髁间距离和骺板距离均与随访天数呈显著正相关，Pearson R 值分别为 0.90（P<0.001）和 0.84（P<0.001）。多元回归分析显示，随访天数是骺板距离的唯一显著预测因素，而年龄、性别、骺板破坏百分比和钉完全穿过骺板均不是显著预测因素。5 例患者的钉完全穿过骺板，未发现生长停滞。
据我们所知，这是第一项评估经逆行钉治疗开放的股骨远端骺板股骨干骨折的研究。在儿童人群中，逆行股骨髓内钉的使用似乎不会在术后导致受伤股骨生长停滞，在其他手术选择不可用时，可能是一种合理的治疗选择。需要进一步的研究来进一步评估安全性。
治疗性 IV 级。欲了解完整的证据等级描述，请参见作者指南。
