Skip to main content
Top
Published in: European Journal of Orthopaedic Surgery & Traumatology 1/2014

01-01-2014 | Original Article

Biological fixation of fracture shaft femur in children

Author: Hatem S. A. Elgohary

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 1/2014

Login to get access

Abstract

The aim of this work was to assess the results of biological fixation of fracture shaft femur in children with locked plates. Twenty-eight fractures in 26 children with closed fractures of the shaft of the femur were managed with biological plating using locked plates bridging the fracture site applied submuscularly through two small incisions above and below the fracture site. The mean age of the patients was 11.2 years; all patients had radiological union within a mean time of 11.9 weeks (8–14 weeks); the average follow-up was 31 months (14–40 months). No patient had frontal or sagittal plane deformity more than 10° or limb length discrepancy more than 1.5 cm. There was no infection, delayed union, nonunion or clinically evident malrotation. A significant positive correlation between the age and the time to healing (p = 0.03) was detected, whereas there was no significant correlation between time to healing and patient sex, fracture level, fracture type, mechanism of injury. Also there was no significant correlation between limb length discrepancy and patient age, sex, fracture level, fracture type, and mechanism of injury. Biological fixation of fractures of the femoral shaft in children with locked plates is a reliable method of fixation with excellent healing potential and fixation mechanics without complications.
Literature
1.
go back to reference Hinton RY, Lincoln A, Crockett MM, Sponseller P, Smith G (1999) Fractures of the femoral shaft in children. Incidence, mechanisms, and sociodemographic risk factors. J Bone Joint Surg 81-A:500–509 Hinton RY, Lincoln A, Crockett MM, Sponseller P, Smith G (1999) Fractures of the femoral shaft in children. Incidence, mechanisms, and sociodemographic risk factors. J Bone Joint Surg 81-A:500–509
2.
go back to reference Loder RT, O’Donnell PW, Feinberg JR (2006) Epidemiology and mechanisms of femur fractures in children. J Pediatr Orthop 26:561–566PubMedCrossRef Loder RT, O’Donnell PW, Feinberg JR (2006) Epidemiology and mechanisms of femur fractures in children. J Pediatr Orthop 26:561–566PubMedCrossRef
3.
go back to reference Blasier RD, Aronson J, Tursky EA (1997) External fixation of pediatric femur fractures. J Pediatr Orthop 17:342–346PubMed Blasier RD, Aronson J, Tursky EA (1997) External fixation of pediatric femur fractures. J Pediatr Orthop 17:342–346PubMed
4.
go back to reference Kasser JR (1996) Femoral shaft fractures. In: Rockwood CA Jr, Wilkins KE, Beaty JH (eds) Fractures in children. Lippincott-Raven, Philadelphia, pp 1195–1230 Kasser JR (1996) Femoral shaft fractures. In: Rockwood CA Jr, Wilkins KE, Beaty JH (eds) Fractures in children. Lippincott-Raven, Philadelphia, pp 1195–1230
5.
go back to reference Ramseier LE, Bhaskar AR, Cole WG, Howard AW (2007) Treatment of open femur fractures in children: comparison between external fixator and intramedullary nailing. J Pediatr Orthop 27:748–750PubMedCrossRef Ramseier LE, Bhaskar AR, Cole WG, Howard AW (2007) Treatment of open femur fractures in children: comparison between external fixator and intramedullary nailing. J Pediatr Orthop 27:748–750PubMedCrossRef
6.
go back to reference Luhmann SJ, Schootman M, Schoenecker PL, Dobbs MB, Gordon JE (2003) Complications of titanium elastic nails for pediatric femoral shaft fractures. J Pediatric Orthop 23:443–447 Luhmann SJ, Schootman M, Schoenecker PL, Dobbs MB, Gordon JE (2003) Complications of titanium elastic nails for pediatric femoral shaft fractures. J Pediatric Orthop 23:443–447
7.
go back to reference Gordon JE, Swenning TA, Burd TA, Szymanski DA, Schoenecker PL (2003) Proximal femoral radiographic changes after lateral transtrochanteric intramedullary nail placement in children. J Bone Joint Surg 85-A:1295–1301PubMed Gordon JE, Swenning TA, Burd TA, Szymanski DA, Schoenecker PL (2003) Proximal femoral radiographic changes after lateral transtrochanteric intramedullary nail placement in children. J Bone Joint Surg 85-A:1295–1301PubMed
8.
go back to reference Kanellopoulos AD, Yiannakopoulos CK, Soucacos PN (2006) Closed, locked intramedullary nailing of pediatric femoral shaft fractures through the tip of the greater trochanter. J Trauma 60:217–222 (discussion 222–223)PubMedCrossRef Kanellopoulos AD, Yiannakopoulos CK, Soucacos PN (2006) Closed, locked intramedullary nailing of pediatric femoral shaft fractures through the tip of the greater trochanter. J Trauma 60:217–222 (discussion 222–223)PubMedCrossRef
9.
go back to reference Hedequist D, Bishop J, Hresko T (2008) Locking plate fixation for pediatric femur fractures. J Pediatr Orthop 28:6–9PubMedCrossRef Hedequist D, Bishop J, Hresko T (2008) Locking plate fixation for pediatric femur fractures. J Pediatr Orthop 28:6–9PubMedCrossRef
10.
go back to reference Sink EL, Hedequist D, Morgan SJ, Hresko T (2006) Results and technique of unstable pediatric femoral fractures treated with submuscular bridge plating. J Pediatr Orthop 26:177–181PubMedCrossRef Sink EL, Hedequist D, Morgan SJ, Hresko T (2006) Results and technique of unstable pediatric femoral fractures treated with submuscular bridge plating. J Pediatr Orthop 26:177–181PubMedCrossRef
11.
go back to reference Muller ME, Allgower M, Schneider R, Willenegger H (1995) Manual of internal fixation: techniques recommended by the AO ASIF group, 3rd edn. Springer, New York Muller ME, Allgower M, Schneider R, Willenegger H (1995) Manual of internal fixation: techniques recommended by the AO ASIF group, 3rd edn. Springer, New York
12.
go back to reference Karnezis IA, Miles AW, Cunningham JL, Learmonth ID (1998) Biological internal fixation of long bone fractures: a biomechanical study of a noncontact plate system. Injury 29(9):689–695PubMedCrossRef Karnezis IA, Miles AW, Cunningham JL, Learmonth ID (1998) Biological internal fixation of long bone fractures: a biomechanical study of a noncontact plate system. Injury 29(9):689–695PubMedCrossRef
13.
go back to reference Riemer B (2003) Controversies and perils plating diaphyseal fractures. Tech Orthop 18(4):360–367CrossRef Riemer B (2003) Controversies and perils plating diaphyseal fractures. Tech Orthop 18(4):360–367CrossRef
14.
go back to reference Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J (2001) Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications. J Pediatr Orthop 21:4–8PubMedCrossRef Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J (2001) Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications. J Pediatr Orthop 21:4–8PubMedCrossRef
15.
go back to reference Sink E, Gralla J, Repine M (2005) Complications of pediatric femur fractures treated with titanium elastic nails. J Pediatr Orthop 25:577–580PubMedCrossRef Sink E, Gralla J, Repine M (2005) Complications of pediatric femur fractures treated with titanium elastic nails. J Pediatr Orthop 25:577–580PubMedCrossRef
16.
go back to reference Stans AA, Morrissy RT, Renwick SE (1999) Femoral shaft fracture treatment in patients aged 6 to 16 years. J Pediatr Orthop 19:222–228PubMed Stans AA, Morrissy RT, Renwick SE (1999) Femoral shaft fracture treatment in patients aged 6 to 16 years. J Pediatr Orthop 19:222–228PubMed
17.
go back to reference Davis TJ, Topping RE, Blanco JS (1995) External fixation of pediatric femoral fractures. Clin OrthopRelat Res 318:191–198 Davis TJ, Topping RE, Blanco JS (1995) External fixation of pediatric femoral fractures. Clin OrthopRelat Res 318:191–198
18.
go back to reference Probe R, Lindsey RW, Hadley NA, Barnes DA (1993) Refracture of adolescent femoral shaft fractures: a complication of external fixation. A report of two cases. J Pediatr Orthop 13:102–105PubMedCrossRef Probe R, Lindsey RW, Hadley NA, Barnes DA (1993) Refracture of adolescent femoral shaft fractures: a complication of external fixation. A report of two cases. J Pediatr Orthop 13:102–105PubMedCrossRef
19.
go back to reference Hehl G, Kiefer H, Bauer G, Völck C (1993) Post-traumatic leg length inequality after conservative and surgical therapy of pediatric femoral shaft fractures. Unfallchirurg 96:651–655PubMed Hehl G, Kiefer H, Bauer G, Völck C (1993) Post-traumatic leg length inequality after conservative and surgical therapy of pediatric femoral shaft fractures. Unfallchirurg 96:651–655PubMed
20.
go back to reference Eren OT, Kucukkaya M, Kockesen C, Kabukcuoglu Y, Kuzgun U (2003) Open reduction and plate fixation of femoral shaft fractures in children aged 4 to 10. J Pediatr Orthop 23:190–193PubMed Eren OT, Kucukkaya M, Kockesen C, Kabukcuoglu Y, Kuzgun U (2003) Open reduction and plate fixation of femoral shaft fractures in children aged 4 to 10. J Pediatr Orthop 23:190–193PubMed
21.
go back to reference Canale ST, Tolo VT (1995) Fractures of the femur in children: an instruction course lecture. J Bone Joint Surg Am 77:294–315 Canale ST, Tolo VT (1995) Fractures of the femur in children: an instruction course lecture. J Bone Joint Surg Am 77:294–315
22.
go back to reference Oh CW, Song HR, Jeon IH, Min WK, Park BC (2007) Nail-assisted Percutaneous Plating of Pediatric Femoral Fractures. Clin Orthop Relat Res 456:176–181PubMedCrossRef Oh CW, Song HR, Jeon IH, Min WK, Park BC (2007) Nail-assisted Percutaneous Plating of Pediatric Femoral Fractures. Clin Orthop Relat Res 456:176–181PubMedCrossRef
23.
go back to reference Kiner DW, Rouhipour V, Kellam JF (2007) Biomechanics of locked plate fixation. Tech Orthop 22(3):151–155CrossRef Kiner DW, Rouhipour V, Kellam JF (2007) Biomechanics of locked plate fixation. Tech Orthop 22(3):151–155CrossRef
24.
go back to reference Claes L (2011) Biomechanical principles and mechanobiologic aspects of flexible and locked plating. J Orthop Trauma 25:S4–S7PubMedCrossRef Claes L (2011) Biomechanical principles and mechanobiologic aspects of flexible and locked plating. J Orthop Trauma 25:S4–S7PubMedCrossRef
25.
go back to reference Perren SM (2002) Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 84:1093–1110PubMedCrossRef Perren SM (2002) Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 84:1093–1110PubMedCrossRef
26.
go back to reference Heitemeyer U, Kemper F, Hierholzer G, Haines J (1987) Severely comminuted femoral shaft fractures: treatment by bridging-plate osteosynthesis. Arch Orthop Trauma Surg 106:327–330PubMedCrossRef Heitemeyer U, Kemper F, Hierholzer G, Haines J (1987) Severely comminuted femoral shaft fractures: treatment by bridging-plate osteosynthesis. Arch Orthop Trauma Surg 106:327–330PubMedCrossRef
27.
go back to reference Bottlang M, Lesser M, Koerber J et al (2010) Far cortical locking can improve healing of fractures stabilized with locking plates. J Bone Joint Surg Am 92-A:1652–1660CrossRef Bottlang M, Lesser M, Koerber J et al (2010) Far cortical locking can improve healing of fractures stabilized with locking plates. J Bone Joint Surg Am 92-A:1652–1660CrossRef
28.
go back to reference Lujan TJ, Henderson CE, Madey SM, Fitzpatrick DC, Marsh JL, Bottlang M (2010) Locked plating of distal femur fractures leads to inconsistent and asymmetric callus formation. J Orthop Trauma 24:156–162PubMedCrossRef Lujan TJ, Henderson CE, Madey SM, Fitzpatrick DC, Marsh JL, Bottlang M (2010) Locked plating of distal femur fractures leads to inconsistent and asymmetric callus formation. J Orthop Trauma 24:156–162PubMedCrossRef
29.
go back to reference Claes L, Heitemeyer U, Krischak G, Braun H, Hierholzer G (1999) Fixation technique influences osteogenesis of comminuted fractures. Clin OrthopRelat Res 365:221–229CrossRef Claes L, Heitemeyer U, Krischak G, Braun H, Hierholzer G (1999) Fixation technique influences osteogenesis of comminuted fractures. Clin OrthopRelat Res 365:221–229CrossRef
Metadata
Title
Biological fixation of fracture shaft femur in children
Author
Hatem S. A. Elgohary
Publication date
01-01-2014
Publisher
Springer Paris
Published in
European Journal of Orthopaedic Surgery & Traumatology / Issue 1/2014
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-012-1121-x

Other articles of this Issue 1/2014

European Journal of Orthopaedic Surgery & Traumatology 1/2014 Go to the issue