Gregory P, Pevny T, Teague D
Orthopaedic Trauma Service, Tampa General Hospital, Florida, USA.
J Orthop Trauma. 1996;10(3):191-8. doi: 10.1097/00005131-199604000-00007.
A retrospective study of 27 pediatric patients with femoral shaft fractures treated by external fixation was made to identify complications and evaluate outcomes. The average age at the time of injury was 8 years, 9 months (range 5 years, 6 months to 13 years, 2 months). Sixteen fractures were isolated, and nine were associated with polytrauma. There was only one open fracture. Data obtained from chart review (n = 27), radiographs (n = 27), physical exam (n = 16), and questionnaire (n = 21) identified eight major complications (30%) in six patients and 29 minor complications (107%) in 20 patients. The major complications included two refractures, two fractures through pin sites, one postimmobilization supracondylar femoral fracture, one persistent pin-tract infection requiring early fixator removal, one malreduction, and one loss of reduction. Both the patient with malreduction and the one who lost reduction had > 10 degrees of varus deformity before adjustment of their frames. Five of the eight major complications (64%) were secondary to errors in operative technique or postoperative treatment. Only one major complication was noted among the 16 patients with isolated injuries. Of the patients with minor complications, 14 had pin-tract infections requiring oral antibiotics, five refused to go to school with the fixator in place, five were dissatisfied with scar appearance, and five had clinically insignificant malunions. A clinically insignificant malunion was considered to be angulation > or = 5 degrees varus or valgus or > or = 10 degrees procurvatum or recurvatum deformity that did not affect the patient's function. The minor complications were considered intrinsic to the procedure and difficult to avoid. Despite these problems, all patients with isolated injuries, except one with a slipped capital femoral epiphysis, had excellent function at the time of final review. If external fixation is chosen as the method of treatment for a pediatric femur fracture, careful attention must be paid to operative technique and postoperative treatment in order to minimize complications.
对27例采用外固定治疗的股骨干骨折患儿进行回顾性研究，以确定并发症并评估治疗结果。受伤时的平均年龄为8岁9个月（范围为5岁6个月至13岁2个月）。16例为单纯骨折，9例合并多发伤。仅1例开放性骨折。通过病历回顾（n = 27）、X线片（n = 27）、体格检查（n = 16）和问卷调查（n = 21）获得的数据显示，6例患者出现8种主要并发症（30%），20例患者出现29种次要并发症（107%）。主要并发症包括2例再骨折、2例穿针部位骨折、1例固定后股骨髁上骨折、1例持续的针道感染需早期拆除固定器、1例复位不良和1例复位丢失。复位不良和复位丢失的患者在调整外固定架前均有>10度的内翻畸形。8种主要并发症中的5种（64%）继发于手术技术或术后治疗失误。16例单纯损伤患者中仅发现1例主要并发症。在有次要并发症的患者中，14例有针道感染需口服抗生素，5例因佩戴固定器而拒绝上学，5例对瘢痕外观不满意，5例有临床意义不显著的骨不连。临床意义不显著的骨不连被定义为内翻或外翻成角≥5度或前凸或后凸成角≥-10度且不影响患者功能。次要并发症被认为是该治疗方法固有的且难以避免。尽管存在这些问题，但除1例股骨头骨骺滑脱患者外，所有单纯损伤患者在最终复查时功能均良好。如果选择外固定作为小儿股骨干骨折的治疗方法，必须仔细注意手术技术和术后治疗，以尽量减少并发症。
