Doshi Rajiv P, Carpenter Claire
Trauma and Orthopaedics, University Hospital of Wales, Cardiff, GBR.
Cureus. 2022 Oct 31;14(10):e30917. doi: 10.7759/cureus.30917. eCollection 2022 Oct.
Femoral shaft fractures in children have seen a number of interesting developments over the past 20 years. This is a retrospective cohort study looking into epidemiological and outcomes data of femoral shaft fractures in children treated at a tertiary centre in Wales from 2005-2021. Over a period of 16 years, there has been a significant increase in the number of rigid or elastic nailing and submuscular plating, coinciding with a dramatic reduction of external fixation for definitive treatment of diaphyseal femoral fractures. All patients above five years of age underwent operative fixation, with elastic or rigid intramedullary nailing the treatment of choice. Following multiple linear regression with 16 possible explanatory factors, this study found a statistically significant increase in time to union for open fractures, pre-operative translation, and operation time. Furthermore, there was a significant increase in post-operative leg length discrepancy for right versus left-sided fractures. Overall complication rates were 4% for minor and 8% for major complications. Complication rates were lowest for rigid intramedullary nailing and highest for external fixation. No cases of avascular necrosis were found for 27 rigid intramedullary nails inserted. Overall this study reports treatment choices and outcomes in keeping with current trends in management for paediatric femoral shaft fractures.
在过去20年里，儿童股骨干骨折出现了许多有趣的进展。这是一项回顾性队列研究，调查了2005年至2021年在威尔士一家三级中心接受治疗的儿童股骨干骨折的流行病学和预后数据。在16年的时间里，刚性或弹性髓内钉固定和肌下钢板固定的数量显著增加，同时用于股骨干骨折确定性治疗的外固定显著减少。所有五岁以上的患者均接受手术固定，弹性或刚性髓内钉是首选治疗方法。在对16个可能的解释因素进行多元线性回归后，本研究发现开放性骨折的愈合时间、术前移位和手术时间在统计学上显著增加。此外，右侧与左侧骨折的术后腿长差异显著增加。总体并发症发生率轻微的为4%，严重的为8%。刚性髓内钉固定的并发症发生率最低，外固定的并发症发生率最高。在插入的27根刚性髓内钉中未发现缺血性坏死病例。总体而言，本研究报告的治疗选择和结果与当前儿童股骨干骨折的治疗趋势一致。
