Lu Yunan, Canavese Federico, Lin Ran, Chen Jinchen, Chen Yibin, Huang Yuling, Chen Shunyou
Department of Pediatric Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, The Third Clinical Medicine College of Fujian Medical University, Fuzhou, China.
Department of Pediatric Orthopedic Surgery, Jeanne de Flandre Hospital, Lille University Centre, Lille, France.
Front Pediatr. 2022 Jun 30;10:914834. doi: 10.3389/fped.2022.914834. eCollection 2022.
Unstable femoral shaft fractures (UFSFs) in children aged 5-11 years remain challenging due to their intrinsic instability. The aim of this study was to evaluate the clinical and radiographic outcomes of UFSF in children aged 5 to 11 years managed by the combined use of ESIN and temporary EF.
Children with UFSF (long oblique and comminuted) treated by ESIN and temporary EF were retrospectively reviewed. Sex, age at injury, side involved, type of fracture, presence or absence of associated lesions or neurovascular complications, type of treatment, time from trauma to surgery, duration of surgery, radiation exposure and length of postoperative immobilization were collected from the medical charts. Radiological and functional outcomes were evaluated according to Beaty's and Flynn's criteria, respectively.
A total of 28 consecutive patients with closed or open (Gustilo type I or II) UFSF were reviewed (18 boys and 10 girls). The mean age at injury was 8.7 ± 1.6 years (range, 5-11); the average weight was 38.1 ± 7.6 kg (range, 26-55). The mean hospital stay was 3.7 ± 1.4 days (range, 2-7), and the mean time to EF and ESIN removal was 6.5 ± 1.1 weeks (range, 4-8) and 9.4 ± 1.6 months (range, 6-12), respectively. Twenty-seven out of 28 patients had excellent radiographic outcomes according to Beaty's criteria, and 24/28 had excellent functional outcomes according to Flynn's criteria. Overall, 4 complications (14.3%) were recorded. No statistically significant correlation was found between complication rates and sex, age, weight or fracture characteristics ( < 0.05).
The combined use of ESIN and temporary EF provides good clinical and radiological outcomes in children with UFSF aged between 5 and 11 years, with a reduced complication rate.
5至11岁儿童的不稳定股骨干骨折（UFSF）因其内在不稳定性，治疗仍具有挑战性。本研究的目的是评估采用弹性髓内钉（ESIN）联合临时外固定架（EF）治疗5至11岁儿童UFSF的临床和影像学结果。
回顾性分析采用ESIN联合临时EF治疗的UFSF（长斜形和粉碎性）患儿。从病历中收集患儿的性别、受伤年龄、受累侧别、骨折类型、是否存在相关损伤或神经血管并发症、治疗方式、受伤至手术时间、手术时长、辐射暴露情况以及术后固定时间。分别根据比蒂（Beaty）和弗林（Flynn）标准评估影像学和功能结果。
共纳入28例闭合性或开放性（Gustilo I型或II型）UFSF患儿进行回顾性分析（18例男孩，10例女孩）。平均受伤年龄为8.7±1.6岁（范围5至11岁）；平均体重为38.1±7.6千克（范围26至55千克）。平均住院时间为3.7±1.4天（范围2至7天），临时外固定架和弹性髓内钉取出的平均时间分别为6.5±1.1周（范围4至8周）和9.4±1.6个月（范围6至12个月）。根据比蒂标准，28例患儿中有27例获得了良好的影像学结果；根据弗林标准，24/28例患儿获得了良好的功能结果。总体而言，记录到4例并发症（14.3%）。并发症发生率与性别、年龄、体重或骨折特征之间未发现统计学显著相关性（P<0.05）。
ESIN联合临时EF治疗5至11岁UFSF患儿可获得良好的临床和影像学结果，且并发症发生率较低。
