Giresun University Faculty of Medicine, Department of Orthopaedics and Traumatalogy, Giresun.
Karabük University Faculty of Medicine, Department of Orthopaedics and Traumatalogy, Karabük.
J Pediatr Orthop. 2022 Sep 1;42(8):e828-e832. doi: 10.1097/BPO.0000000000002207. Epub 2022 Jul 14.
Subtrochanteric femur fractures are unstable injuries due to strong muscle forces on the proximal femur. The ideal fixation device is controversial in the treatment of subtrochanteric femur fractures in children. The aim of this study is to evaluate the clinical and radiological outcomes of subtrochanteric femur fractures in children treated with an adult proximal humerus plate.
A total of 9 patients [mean age at surgery, 8.3 years (range: 7 to 12); mean follow-up period, 28.1 months (range: 12 to 56)] who underwent surgery due to a subtrochanteric femur fracture and treated with an adult proximal humerus between January 2017 and December 2021 were retrospectively evaluated. Four of the patients had a pathological fracture associated with a benign bone tumor while 5 patients had a nonpathological fracture. The clinical and radiological outcomes were assessed using the Flynn scoring system at the latest follow-up. Time to union and complications were recorded.
All patients demonstrated a solid fusion of the fracture site and were able to bear full weight at the latest follow-up. The mean time to union was 8.2 weeks (range: 6 to 10). Based on the Flynn scoring system at the latest follow-up, seven patients had excellent clinical outcomes and two patients had satisfactory outcomes. Two patients had limb length discrepancy, and one patient had coxa valga and a limb length discrepancy of 16 mm. There were no patients with nonunion, infection, implant failure, osteonecrosis of the femoral head, and heterotopic bone formation.
This study suggests that the adult proximal humerus plate may be an effective alternative fixation option in the treatment of subtrochanteric femur fractures in children, including pathological fractures.
Level IV, Case series.
由于股骨近端的强大肌肉力量，股骨转子下骨折是一种不稳定的损伤。在儿童股骨转子下骨折的治疗中，理想的固定装置存在争议。本研究旨在评估儿童股骨转子下骨折采用成人肱骨近端接骨板治疗的临床和影像学结果。
回顾性分析 2017 年 1 月至 2021 年 12 月期间因股骨转子下骨折接受手术并采用成人肱骨近端接骨板治疗的 9 例患儿（手术时平均年龄 8.3 岁[范围：712 岁]；平均随访时间 28.1 个月[范围：1256 个月]）。其中 4 例为伴良性骨肿瘤的病理性骨折，5 例为非病理性骨折。在末次随访时，采用 Flynn 评分系统评估临床和影像学结果。记录愈合时间和并发症。
所有患者的骨折部位均达到骨性愈合，在末次随访时均能完全负重。平均愈合时间为 8.2 周（范围：6~10 周）。根据末次随访时的 Flynn 评分系统，7 例患者的临床结果为优秀，2 例为满意。2 例患者存在肢体长度差异，1 例患者存在髋内翻和 16mm 的肢体长度差异。无患者出现骨不连、感染、内固定失败、股骨头坏死和异位骨形成。
本研究表明，成人肱骨近端接骨板可能是治疗儿童股骨转子下骨折（包括病理性骨折）的一种有效固定选择。
IV 级，病例系列研究。
