Duan Lian,Li Lianyong.Comparative study of closed reduction hip cast fixation versus elastic intramedullary nail fixation in treatment of femoral shaft fractures in preschool children[J].Journal of Clinical Pediatric Surgery,,():572-577.[doi:10.3760/cma.j.cn101785-202304020-012]
Comparative study of closed reduction hip cast fixation versus elastic intramedullary nail fixation in treatment of femoral shaft fractures in preschool children
- Keywords:
- Femoral Shaft Fractures; Closed Fracture Reduction; Fracture Fixation; Intramedullary; Casts; Surgical; Child; Preschool
- Abstract:
- Objective To compare the clinical efficacy of closed reduction with spica casting (SC) versus flexible intramedullary nail (FIN) for femoral shaft fractures in preschool children.Methods A retrospective chart review was performed to identify children two to five years of age who had been treated for femoral shaft fracture.According to treatments,they were assigned into two groups of SC and FIN (n=20 each).Demographic profiles,associated injuries,injury severity,time indicators,total hospitalization expense,radiographic outcomes and complications were compared between two groups.Results A total of 40 children with a mean age of 37.73(24-57) month fulfilled the inclusion criteria.There were 28 boys and 12 girls.In SC and FIN groups,the percentage of associated injuries was 5% and 40%;Median Injury Severity Score (ISS) 9.0(9.0,9.0) and 10.0(9.0,13.8) (P=0.005);union time (52.90±10.30) and (53.05±10.85) day (P=0.950);full weight-bearing time (107.35±14.66) and (102.50±22.70) day (P=0.430);operative duration (34.95±17.63) and (102.70±27.93) min (P<0.001);median length of postoperative hospital stay 1.5(1.0,2.0) and 2.0 (2.0,3.0) day (P=0.075);total hospitalization expense (12 750.9±3 790.4) and (35 196.9±4 893.2) yuan (P<0.001);coronal angulation 6.5(4.3,8.8)°,5.0(2.0,13.0)°,3.0(2.0,5.0)°,3.0(2.0,4.0)°,2.0(2.0,3.8)°,2.0(1.0,2.0)° at fracture union,full weight bearing and last follow-up (P<0.001);sagittal angulation 9.5(6.3,13.0)°,8.5(5.3,11.5)°,5.0(3.3,7.8)°,4.0(2.0,5.0)°,3.0(2.0,4.0)°,2.0(2.0,3.0)°(P<0.001).At the last follow-up,limb length discrepancy was (5.30±3.26) in SC group and (7.78±5.01) mm in FIN group (P=0.073);excellent/decent rate of Flynn score 90% and 95%.And the difference was not statistically significant (P=0.800).The incidence of postoperative complications was 10% in both groups.All complications were classified as Clavien-Dindo grade-Ⅰ/Ⅱ.Conclusions No significant difference exists in short-term healing process between two treatment modes under current domestic medical model.As compared with SC,FIN is more expensive and requires a second surgery for removing nails.Long-term efficacy of two treatment methods and family burden of care should be further examined in the future.
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Memo
收稿日期:2023-04-06。
通信作者:李连永,Email:loyo_ldy@163.com