Once the patients guardian has been informed of available therapies and has discussed. Treatment includes conservative nonsurgical or surgical methods but the choice of treatment differs depending on the childs age, fracture pattern, other concomitant fractures and the socioeconomic situation of the family. Pediatric femur fractures a practical guide to evaluation. Titanium elastic nailing in pediatric femoral diaphyseal fractures in the age group of 516 years a short term study. Limited evidence supports treatment with a pavlik harness or a spica cast for infants aged 6 months or younger with a diaphyseal femur fracture.
Left an oblique, displaced fracture of the femur shaft. The treatment of pediatric diaphyseal femur fractures, particularly lengthunstable fractures, continues to be an area of controversy in patients from age 6 to skeletal maturity. Retrospective, multicenter evaluation of complications in the. Request pdf treatment of pediatric diaphyseal femur fractures. This article has been cited by 1 surgical treatment of femoral diaphyseal fractures in children using elastic stable intramedullary nailing by open reduction at yopougon teaching hospital j.
A marked increase occurs in those over age 75 years. Fractures using an interlocking pediatric femoral nail and a lateral trocanteric entry point. In many developing countries the 90cc motorbike has become the family vehicle of choice. This study compared the radiographic and clinical outcomes of pediatric diaphyseal femur fractures treated by submuscular plating, flexible retrograde intramedullary nailing, or rigid antegrade intramedullary nailing with a trochanteric entry point in skeletally immature patients who were 8 years and older. Inclusion criteria involved closed diaphyseal or metaphyseo diaphyseal fractures of femur or tibia, patients between 5 to14years who did not receive conservative measures. Clinical practice guideline on the treatment of pediatric diaphyseal femur fractures.
Surgical treatment of traumatic pediatric humeral diaphyseal. Femoral shaft fractures pediatric pediatrics orthobullets. Current evidence is reflective of this variation with most evidence cited by the american academy of orthopedic surgeons being level 4 or 5. Nov 01, 2016 this study compared the radiographic and clinical outcomes of pediatric diaphyseal femur fractures treated by submuscular plating, flexible retrograde intramedullary nailing, or rigid antegrade intramedullary nailing with a trochanteric entry point in skeletally immature patients who were 8 years and older. Surgical treatment of femoral diaphyseal fractures in.
Treatment of pediatric diaphyseal femur fractures aaos. Intramedullary elastic nails have become a widely used option for pediatric diaphyseal femur fracture treatment, particularly in patients 6 to 12. Treatment of femur fractures in children and young adults between the age of five and twelve years old has been in transition over the past two decades. Femoral shaft fractures are among the most common diaphyseal fractures in children with an estimated annual incidence of 19 fractures per 100,000 children in the united states. Aug 28, 2016 nonoperative long leg cast indications nondisplaced femoral shaft fractures in patients with multiple medical comorbidities operative antegrade intramedullary nail with reamed technique indications gold standard for treatment of diaphyseal femur fractures outcomes stabilization within 24 hours is associated with decreased pulmonary.
Submuscular locked plate for fixation of pediatric fracture. Other factors that can influence the selection of a techniquewhich range from skeletal traction with spica casting to immediate spica casting, flexible intramedullary nailing, rigid intramedullary rodding, or plate fixationare weight, fracture severity. Hence spontaneous, complete correction after fracture healing is expected. Dec 26, 2016 this was highlighted in a recent case report on a man with osteoporosis pseudoglioma syndrome due to a lrp5 mutation who had an atypical subtrochanteric femur fracture even though he had not been exposed to bisphosphonates. Treatment of pediatric diaphyseal femur fractures with. Diaphyseal femur fractures in osteogenesis imperfecta.
While multiple surgical options exist for this injury in children older than age 5, titanium elastic nailing for fractures has gained the most widespread use, due to ease of insertion, rapid healing, and satisfactory outcomes. Because of this, rapid healing of diaphyseal femur fractures and postfracture skeletal remodeling is maximal. Fall from bed history of femur fracture during delivery treated in pavlik harness i want to. Management of pediatric diaphyseal femur fractures, current. Secondary manual search of the bibliographies of all retrieved.
The american academy of orthopaedic surgeons board of directors approved a new clinical practice guideline for the treatment of pediatric diaphyseal femur fractures. The anatomy and biomechanics of pediatric bone differ from that of adult bone, leading to unique pediatric fracture patterns, healing mechanisms, and management. Aaos clinical practice guideline on the treatment of pediatr. Diaphyseal tibia and femur fractures linkedin slideshare. Pdf the management of paediatric diaphyseal femoral fractures.
The recent trend has been away from nonsurgical treatment and toward surgical stabilization. Pdf the definitive treatment of paediatric femoral diaphyseal fractures remains controversial. The clinical practice guideline on pediatric diaphyseal femur fractures was undertaken to determine the best evidence regarding a number of different options for surgical stabilization. The definitive treatment of paediatric femoral diaphyseal fractures remains controversial. Nov 29, 2016 pediatric diaphyseal femur fractures account for 1. The recommendations address treatments that include pavlik harness, spica casts, flexible intramedullary nailing, rigid trochanteric entry nailing, submuscular. Pediatric femoral shaft fractures orthopaedic trauma association.
A practical guide to evaluation and management pdf author daniel j. Transverse fractures more predictive of nonaccidental trauma compared to spiral or oblique fractures. New guideline for the treatment of pediatric diaphyseal. The treatment of these fractures is dictated by various factors. The entirety of the pediatric femur is considered, including femoral head and neck fractures, diaphyseal, physeal and epiphyseal fractures, and intraarticular fractures of the distal femur. According to the current american academy of orthopaedic surgeons aaos clinical practice guidelines concerning pediatric diaphyseal femur fractures, there is poorquality evidence in support of any specific surgical treatment modality 5. Femoral fractures account for 2% of all fractures in children 1, 2 and are a frequent cause of morbidity in pediatric surgery. Spica casting and traction femoral shaft fractures remain a common musculoskeletal injury requiring inpatient care for children. Treatment of diaphyseal fractures of the femur dff in children has progressed, most recently with elastic stable intramedullary nailing esin, which has made it possible to arrest the complications, severity, and poor results of orthopaedic treatment. Specifically, thighbone fractures are classified depending on.
They are also the most common pediatric fracture of the femur, accounting for up to 62 percent of all femur fractures 3. Pediatric diaphyseal femur fractures account for 1. Treatment of pediatric diaphyseal femur fractures with plate. Using weight as a treatment criterion using any amount of rotation or angulation as a criterion for altering treatment does this help. The associated incidence of pediatric femur fractures and poly trauma is subsequently increasing. External fixator as primary and definitive treatment of. Modalities of treatment vary mostly according to age, with fracture pattern and site having a lesser impact. Practice guideline on the treatment of pediatric diaphyseal femur fractures. Clinical practice guidelines cpg provide evidencebased recommendations for current orthopaedic diagnostic, treatment, and postoperative procedures.
Bringing together the many considerations and complexities surrounding the management pediatric femur fractures, this. Treatment of pediatric diaphyseal femur fractures case study. Pediatric femur fractures pdf download medical books. The incidence of femoral, particularly diaphyseal, fractures due to severe trauma is greatest in young men. Patients demographic data, mode of injury, union rate, and complication rates were evaluated.
Management of pediatric femur fractures with a single semi. In comparison to adult bone, pediatric bone is significantly less dense, more porous and penetrated throughout by capillary channels. Simple fractures closed fractures exclusion criteria 1. The reduction was good, the callus was suffi cient after 3 months. Treatment of pediatric diaphyseal femur fractures case study introduction isolated pediatric femoral shaft fractures occur at an annual rate of 19 per 100,000 and represent the most frequent pediatric orthopaedic injury requiring hospitalization 12.
The perfect device would be an easy internal fixation that allows rapid mobilization, holding the fracture in place until it is consolidated. Jul 22, 2009 the american academy of orthopaedic surgeons board of directors approved a new clinical practice guideline for the treatment of pediatric diaphyseal femur fractures. Treatment of pediatric diaphyseal femur fractures request pdf. The past decade has seen a trend away from nonsurgical treatment such as. Full guideline pdf strong evidence supports that children younger than thirtysix months with a diaphyseal. Management of diaphyseal lower limb fractures in paediatric. The management of paediatric diaphyseal femoral fractures. Limited evidence supports treatment with a pavlik harness or a spica cast for infants six months and younger with a diaphyseal femur fracture, because their outcomes are similar. Feb 09, 2012 a variety of strategies are utilized for management of pediatric diaphyseal femur fractures, depending chiefly on the age of the patient. Limited evidence the first 6 months of a childs life is a time of most rapid growth. To further assist presenters, a pdf version of this slide deck, including presenter notes, is also available for download. Management of pediatric femur shaft fractures unm digital.
Treatment of pediatric diaphyseal femur fractures is based on the assumption that decisions are predicated on guardian and physician mutual communication with discussion of available treatments and procedures applicable to the individual patient. The use of submuscular plates for pediatric femur fractures has become more common in the last 10 years. Here we describe a technique of stabilizing pediatric diaphyseal. New guideline for the treatment of pediatric diaphyseal femur. Despite the new treatment options, there is no evidence in literature of an ideal internal fixation for all diaphyseal fractures in pediatric patients. Management of pediatric diaphyseal femur fractures ncbi. The majority of femur fractures occur in the proximal third ie, hip fractures, which are discussed separately. Flexible intramedullary nailing in the treatment of diaphyseal fractures of the femur in preschool children.
Stabilization of pediatric diaphyseal femur fractures with f. Methods of treating pediatric diaphyseal femur fractures are dictated by patient age, fracture characteristics, and family social situation. Jun 08, 2017 femur diaphyseal fracture common injury due to major violent trauma 1 femur fracture 10,000 people more common in people 65 yo femur fracture leads to reduced activity for 107 days, the average length of hospital stay is 25 days 20. Due the rapid union and complete remodeling, treatment of diaphyseal femur fractures centers on assuring ease of patient care and minimizing treatment. Femoral fractures account for 2% of all fractures in children, and are a frequent cause of morbidity in pediatric surgery. Abstractmethods of treating pediatric diaphyseal femur fractures are dictated by patient age, fracture characteristics, and family social situation. The clinical practice guideline on pediatric diaphyseal fe.
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