Qiao Fei, Shang Xinpeng, Jiang Fei
Department of Pediatric Orthopaedic, Dalian Women and Children's Medical Group, Dalian, Liaoning, China.
Front Pediatr. 2024 Apr 11;12:1346456. doi: 10.3389/fped.2024.1346456. eCollection 2024.
The management of femoral fractures in children aged two to six years is still controversial. The purpose of this study was to assess the results of closed reduction and elastic stable intramedullary nail (ESIN) fixation in completely displaced fractures of the femoral diaphysis in children in this age group.
A retrospective review of all children with acute completely displaced fractures of the femoral diaphysis in children aged 2-6 years treated from 2013 to 2020 was performed. A total of 34 patients were treated who met the inclusion criteria: Group 1: 21 fractures (transverse and short oblique); Group 2: 13 fractures (long oblique and spiral) that underwent closed reduction and elastic stable intramedullary nail (ESIN) fixation. No differences existed between the 2 groups with respect to age, extremity, sex, time to treatment, mechanism of injury, or fracture displacement. Demographic characteristics and radiographs were reviewed, and the following parameters were documented: surgery time, time to union, return to activities, range of motion of knee joints, and complications. Major complications were defined as those with presumptive long-term side effects or those requiring a reoperation. No major complications were observed in the two groups. All included fractures were treated by a single senior paediatric surgeon. The mean follow-up period was 28.4 months (range 24-45 months). The level of significance was set at < 0.05.
Thirty-four children with acute completely displaced fractures of the femoral diaphysis were included: Group 1: 21 fractures; Group 2: 13 fractures. The patients included 15 girls (44.1%) and 19 boys (55.9%), with an average age of 4.4 years (range 2.8 to 6.5 years). The mean follow-up period was 28.4 months (range 24.2-45.0 months). The demographic characteristics did not differ between the two groups of patients. Overall, successful closed reduction and elastic stable intramedullary nail (ESIN) fixation could be achieved in all 34 patients. The mean surgical time was 40.4 and 43.0 min in Group 1 and Group 2, respectively ( = 0.857). Fluoroscopy time was not significantly different between the two groups (37.0 vs. 36.1 s, respectively; = 0.247). Cosmetic results were described as good and satisfactory by all patients. There were no refractures and no incidences of nonunion or growth arrest in the proximal epiphysis. Only two patients suffered from a superficial infection, which was resolved after the pins were shortened and oral antibiotics were administered.
Closed reduction and elastic stable intramedullary nail (ESIN) fixation can be successfully used to treat completely displaced fractures of the femoral diaphysis in children aged two to six years. This technique is efficient and minimally invasive, and the results are satisfactory.
2至6岁儿童股骨骨折的治疗仍存在争议。本研究的目的是评估闭合复位及弹性稳定髓内钉（ESIN）固定治疗该年龄组儿童股骨干完全移位骨折的效果。
对2013年至2020年治疗的所有2至6岁急性股骨干完全移位骨折儿童进行回顾性研究。共有34例符合纳入标准的患者接受治疗：第1组：21例骨折（横行和短斜行）；第2组：13例骨折（长斜行和螺旋形），均接受了闭合复位及弹性稳定髓内钉（ESIN）固定。两组在年龄、肢体、性别、治疗时间、损伤机制或骨折移位方面无差异。回顾人口统计学特征和X线片，并记录以下参数：手术时间、愈合时间、恢复活动情况、膝关节活动范围及并发症。主要并发症定义为具有假定长期副作用或需要再次手术的并发症。两组均未观察到主要并发症。所有纳入骨折均由一名资深小儿外科医生治疗。平均随访期为28.4个月（范围24 - 45个月）。显著性水平设定为<0.05。
纳入34例急性股骨干完全移位骨折儿童：第1组：21例骨折；第2组：13例骨折。患者包括15名女孩（44.1%）和19名男孩（55.9%），平均年龄4.4岁（范围2.8至6.5岁）。平均随访期为28.4个月（范围24.2 - 45.0个月）。两组患者的人口统计学特征无差异。总体而言，34例患者均成功实现了闭合复位及弹性稳定髓内钉（ESIN）固定。第1组和第2组的平均手术时间分别为40.4分钟和43.0分钟（P = 0.857）。两组的透视时间无显著差异（分别为37.0秒和36.1秒；P = 0.247）。所有患者对外观效果的评价均为良好和满意。无再骨折发生，近端骨骺无骨不连或生长停滞情况。仅2例患者发生浅表感染，在缩短钢针并给予口服抗生素后感染得到解决。
闭合复位及弹性稳定髓内钉（ESIN）固定可成功用于治疗2至6岁儿童股骨干完全移位骨折。该技术高效且微创，效果满意。
