Tepecik Training and Research Hospital, Department of Orthopaedics and Traumatology, İzmir, Turkey.
Tepecik Training and Research Hospital, Department of Orthopaedics and Traumatology, İzmir, Turkey.
Injury. 2022 Mar;53(3):1013-1019. doi: 10.1016/j.injury.2021.09.055. Epub 2021 Oct 1.
There is no detailed data on the factors affecting the re-displacement in pediatric femoral fractures treated with closed reduction and early spica casting. This study aimed to investigate the factors effective in re-displacement in pediatric diaphyseal femur fractures (PDFF) treated with spica casting.
In all, 151 displaced PDFF were evaluated retrospectively. Demographic data of the patients were evaluated. Type of fractures, anteroposterior and lateral angulations, amount of shortening, translation ratio, cast index (CI), gap index (GI), and three-point index (TPI) measurements were evaluated radiologically. Thigh flexion angle (TFA) and knee flexion angle (KFA) were measured. After casting, angulation of more than 10° in any plane and a shortening of more than 10 mm was accepted as re-displacement. Binary logistic regression analysis was used to evaluate the risk factors of re-displacement. Receiver operating characteristic analysis was performed for TFA and KFA.
Re-displacement was detected in 40 patients (26.5%). Transverse type fracture (p = 0.001), TFA ˂71.4° (p <0.001), and KFA ˂52.6° (p = 0.002) were found to be statistically significant factors on re-displacement. It was determined that the combination of transverse femoral fracture and TFA ˂71.4° increased the probability of re-displacement by approximately 14 times. It has been observed that indices such as CI, GI, and TPI were not effective in predicting the risk of re-displacement.
When treating a PDFF with spica casting, one should be aware of re-displacement if the fracture type is transverse, TFA is ˂71.4°, and KFA is ˂52.6°.
Level III, prognostic.
对于接受闭合复位和早期管型石膏固定治疗的儿童股骨骨折，目前尚无详细数据表明哪些因素会导致再移位。本研究旨在探讨影响儿童骨干股骨骨折（PDFF）经石膏管型固定后再移位的因素。
回顾性评估了 151 例移位 PDFF。评估患者的人口统计学数据。评估骨折类型、前后和侧方成角、缩短程度、移位比例、铸型指数（CI）、间隙指数（GI）和三点指数（TPI）的影像学测量值。测量大腿屈曲角（TFA）和膝关节屈曲角（KFA）。在石膏固定后，任何平面的成角大于 10°和缩短大于 10mm 被接受为再移位。采用二元逻辑回归分析评估再移位的危险因素。进行 TFA 和 KFA 的受试者工作特征分析。
40 例患者（26.5%）发现再移位。横断骨折（p=0.001）、TFA ˂71.4°（p<0.001）和 KFA ˂52.6°（p=0.002）是再移位的统计学显著因素。确定横断股骨骨折和 TFA ˂71.4°的组合使再移位的概率增加了约 14 倍。观察到 CI、GI 和 TPI 等指数对预测再移位风险没有效果。
在使用管型石膏治疗 PDFF 时，如果骨折类型为横断、TFA ˂71.4°和 KFA ˂52.6°，则应注意再移位的发生。
III 级，预后。
