1. A PROSPECTIVE OUTCOME STUDY OF PEDIATRIC FEMUR FRACTURES: TITANIUM ELASTIC NAILING VS. TRACTION AND CASTING
- Author
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Flynn, JM, Dawson, J, D'Italia, J, Drummond, DS, Davidson, RS, Ganley, TJ, Teti, B, Dormans, JP, Gregg, JR, and Ecker, ML
- Subjects
Pediatrics -- Research - Abstract
Introduction: The standard treatment of femoral shaft fractures in young children (immediate spica casting) and in skeletally mature adolescents (rigid antegrade IM nailing) is widely accepted. For children between these ages (~6-16 y/o), traction and spica casting has traditionally been used. There is growing enthusiasm for Titanium Elastic Nails (TEN) for this age group, but no prospective outcome studies have compared TEN to standard traction and casting. We designed a prospective outcome study to compare the clinical, radiographic, functional, emotional, social and financial consequences of femur fracture management in children 6-16 y/o. Methods: After IRB approval, every child 6-16 y/o who presented to our institution with a femoral shaft fracture was enrolled. Surgeon preference determined treatment method, and some surgeons would not use TEN for any fracture. Each family was asked to complete the AAOS Pediatric Outcome Instrument (Baseline and 6 wks., 3 mo., 6 mo., and 1 year Follow Up). In addition to clinical and radiographic information, we documented important recovery milestones (e.g. time absent from school). Complications (unacceptable alignment or leg length inequality, refracture, unplanned re-operation, decubitus ulcers, etc) were recorded. Results: To date, 21 fractures (in 21 children, mean age 8.5 y/o) treated with traction and casting (T&C) and 28 fractures (27 children, mean age 9.9 y/o) treated with TEN have been followed to the clinical endpoint of fracture union and return to full activity. Compared to T&C, children treated with TEN were discharged sooner (4 vs. 19 days), walked sooner (16 vs. 65 days), walked independently sooner (60 vs. 105 days), and returned to school sooner (55 vs. 99 days). Complication, as defined above, occurred in 11/21 (52%) T/C group patients and in 3/28 (9%) fractures treated with TEN. Conclusion: Children 6-16 y/o who had their femoral shaft fracture treated with Titanium Elastic Nailing were mobilized more quickly, returned to school and other normal activities more quickly, and had a lower complication rate than those treated with traction and casting., JM Flynn, MD, J Dawson, RN, J D'Italia, RN, DS Drummond, MD, RS Davidson, MD, TJ Ganley, MD, B Teti, RN, JP Dormans, MD, JR Gregg, MD, ML Ecker, MD [...]
- Published
- 1999