Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000015.xml
Download PDF
Eur J Pediatr Surg 2013; 23(06): 427-433
DOI: 10.1055/s-0033-1360460
DOI: 10.1055/s-0033-1360460
Review Article
Developments in the Treatment of Pediatric Long Bone Shaft Fractures
Further Information
Publication History
01 October 2013
06 October 2013
Publication Date:
10 December 2013 (online)
Abstract
Shaft fractures of the long bones are among the most common pediatric injuries. They are characterized by a limited potential for spontaneous correction because of the fractures—distance to the physis. Although conservative treatment has been practiced for many years with satisfying results, several aspects have led to an increase in the numbers of surgical procedures including changes of living, sports habits, economics, and patients—request to treatment. We reviewed the literature to describe developments of treatment concepts of pediatric shaft fractures. In shaft fractures of the upper extremities, increasing rates of surgical procedures have been reported preventing functional deficits of forearm prosupination and cosmetic deformities of the humerus. In fractures of the lower extremities maximizing stability shifted into the focus of interest to achieve early mobilization and to compensate heavier body weights of children and adolescents. Consecutively, the current gold standard of pediatric shaft fracture treatment—ESIN (elastic stable intramedullary nailing)—has been modified repeatedly using end caps, prebended nails, and optimized surgical techniques. In addition, new methods such as rigid locking nails and plates have been included in the treatment approaches for femur and tibia shaft fractures. All these methods of pediatric fracture care carry inherent advantages that require consideration for each clinical situation. On the other side, this has enlarged the spectrum of potential complications, which needs continuous evaluation to further improve treatment results.
-
References
- 1 Lascombes P, Nespola A, Poircuitte JM , et al. Early complications with flexible intramedullary nailing in childhood fracture: 100 cases managed with precurved tip and shaft nails. Orthop Traumatol Surg Res 2012; 98 (4) 369-375
- 2 Parikh SN, Jain VV, Denning J , et al. Complications of elastic stable intramedullary nailing in pediatric fracture management: AAOS exhibit selection. J Bone Joint Surg Am 2012; 94 (24) e184
- 3 Helenius I, Lamberg TS, Kääriäinen S, Impinen A, Pakarinen MP. Operative treatment of fractures in children is increasing. A population-based study from Finland. J Bone Joint Surg Am 2009; 91 (11) 2612-2616
- 4 Kraus R, Ploss C, Staub L , et al. Fractures of long bones in children and adolescents. Osteosynth Trauma Care 2006; 14: 39-44
- 5 Kasten P, Krefft M, Hesselbach J, Weinberg AM. How does torsional deformity of the radial shaft influence the rotation of the forearm? A biomechanical study. J Orthop Trauma 2003; 17 (1) 57-60
- 6 Bowman EN, Mehlman CT, Lindsell CJ, Tamai J. Nonoperative treatment of both-bone forearm shaft fractures in children: predictors of early radiographic failure. J Pediatr Orthop 2011; 31 (1) 23-32
- 7 Sinikumpu JJ, Lautamo A, Pokka T, Serlo W. Complications and radiographic outcome of children's both-bone diaphyseal forearm fractures after invasive and non-invasive treatment. Injury 2013; 44 (4) 431-436
- 8 Clark EM, Ness AR, Tobias JH. Vigorous physical activity increases fracture risk in children irrespective of bone mass: a prospective study of the independent risk factors for fractures in healthy children. J Bone Miner Res 2008; 23 (7) 1012-1022
- 9 Lazar-Antman MA, Leet AI. Effects of obesity on pediatric fracture care and management. J Bone Joint Surg Am 2012; 94 (9) 855-861
- 10 Sinikumpu JJ, Lautamo A, Pokka T, Serlo W. The increasing incidence of paediatric diaphyseal both-bone forearm fractures and their internal fixation during the last decade. Injury 2012; 43 (3) 362-366
- 11 Valerio G, Gallè F, Mancusi C , et al. Prevalence of overweight in children with bone fractures: a case control study. BMC Pediatr 2012; 12: 166
- 12 Fernandez FF, Langendörfer M, Wirth T, Eberhardt O. Failures and complications in intramedullary nailing of children's forearm fractures. J Child Orthop 2010; 4 (2) 159-167
- 13 Weinberg AM, Amerstorfer F, Fischerauer EE, Pearce S, Schmidt B. Paediatric diaphyseal forearm refractures after greenstick fractures: operative management with ESIN. Injury 2009; 40 (4) 414-417
- 14 Fernandez FF, Egenolf M, Carsten C, Holz F, Schneider S, Wentzensen A. Unstable diaphyseal fractures of both bones of the forearm in children: plate fixation versus intramedullary nailing. Injury 2005; 36 (10) 1210-1216
- 15 Lieber J, Sommerfeldt DW. Diametaphyseal forearm fracture in childhood. Pitfalls and recommendations for treatment. Unfallchirurg 2011; 114 (4) 292-299
- 16 Lieber J, Schmid E, Schmittenbecher PP. Unstable diametaphyseal forearm fractures: transepiphyseal intramedullary Kirschner-wire fixation as a treatment option in children. Eur J Pediatr Surg 2010; 20 (6) 395-398
- 17 Schmittenbecher PP. State-of-the-art treatment of forearm shaft fractures. Injury 2005; 36 (Suppl. 01) A25-A34
- 18 Salonen A, Salonen H, Pajulo O. A critical analysis of postoperative complications of antebrachium TEN-nailing in 35 children. Scand J Surg 2012; 101 (3) 216-221
- 19 Lieber J, Joeris A, Knorr P, Schalamon J, Schmittenbecher P. ESIN in forearm fractures: Clear Indications, Often Used, but Some Avoidable Complications. Eur J Trauma 2005; 31: 3-11
- 20 Sproule JA, Roche SJ, Murthy EG. Attritional rupture of extensor pollicis longus: a rare complication following elastic stable intramedullary nailing of a paediatric radial fracture. Hand Surg 2011; 16 (1) 69-72
- 21 Fernandez FF, Eberhardt O, Langendörfer M, Wirth T. Nonunion of forearm shaft fractures in children after intramedullary nailing. J Pediatr Orthop B 2009; 18 (6) 289-295
- 22 Schmittenbecher PP, Fitze G, Gödeke J, Kraus R, Schneidmüller D. Delayed healing of forearm shaft fractures in children after intramedullary nailing. J Pediatr Orthop 2008; 28 (3) 303-306
- 23 Schmittenbecher PP, Blum J, David S , et al. Treatment of humeral shaft and subcapital fractures in children. Consensus report of the child trauma section of the DGU. Unfallchirurg 2004; 107 (1) 8-14
- 24 Caviglia H, Garrido CP, Palazzi FF, Meana NV. Pediatric fractures of the humerus. Clin Orthop Relat Res 2005; (432) 49-56
- 25 Garg S, Dobbs MB, Schoenecker PL, Luhmann SJ, Gordon JE. Surgical treatment of traumatic pediatric humeral diaphyseal fractures with titanium elastic nails. J Child Orthop 2009; 3 (2) 121-127
- 26 Fernandez FF, Eberhardt O, Wirth T. Elastic stable intramedullary nailing as alternative therapy for the management of paediatric humeral shaft fractures. Z Orthop Unfall 2010; 148 (1) 49-53
- 27 Singisetti K, Ambedkar M. Nailing versus plating in humerus shaft fractures: a prospective comparative study. Int Orthop 2010; 34 (4) 571-576
- 28 Rewers A, Hedegaard H, Lezotte D , et al. Childhood femur fractures, associated injuries, and sociodemographic risk factors: a population-based study. Pediatrics 2005; 115 (5) e543-e552
- 29 Garner MR, Bhat SB, Khujanazarov I, Flynn JM, Spiegel D. Fixation of length-stable femoral shaft fractures in heavier children: flexible nails vs rigid locked nails. J Pediatr Orthop 2011; 31 (1) 11-16
- 30 Levy JA, Podeszwa DA, Lebus G, Ho CA, Wimberly RL. Acute complications associated with removal of flexible intramedullary femoral rods placed for pediatric femoral shaft fractures. J Pediatr Orthop 2013; 33 (1) 43-47
- 31 Sink EL, Faro F, Polousky J, Flynn K, Gralla J. Decreased complications of pediatric femur fractures with a change in management. J Pediatr Orthop 2010; 30 (7) 633-637
- 32 Backstrom IC, MacLennan PA, Sawyer JR, Creek AT, Rue III LW, Gilbert SR. Pediatric obesity and traumatic lower-extremity long-bone fracture outcomes. J Trauma Acute Care Surg 2012; 73 (4) 966-971
- 33 Kessler J, Koebnick C, Smith N, Adams A. Childhood obesity is associated with increased risk of most lower extremity fractures. Clin Orthop Relat Res 2013; 471 (4) 1199-1207
- 34 Lohiya R, Bachhal V, Khan U , et al. Flexible intramedullary nailing in paediatric femoral fractures. A report of 73 cases. J Orthop Surg 2011; 6: 64
- 35 Leet AI, Pichard CP, Ain MC. Surgical treatment of femoral fractures in obese children: does excessive body weight increase the rate of complications?. J Bone Joint Surg Am 2005; 87 (12) 2609-2613
- 36 Ellis HB, Ho CA, Podeszwa DA, Wilson PL. A comparison of locked versus nonlocked Enders rods for length unstable pediatric femoral shaft fractures. J Pediatr Orthop 2011; 31 (8) 825-833
- 37 Nectoux E, Giacomelli MC, Karger C, Gicquel P, Clavert JM. Use of end caps in elastic stable intramedullary nailing of femoral and tibial unstable fractures in children: preliminary results in 11 fractures. J Child Orthop 2008; 2 (4) 309-314
- 38 Volpon JB, Perina MM, Okubo R, Maranho DA. Biomechanical performance of flexible intramedullary nails with end caps tested in distal segmental defects of pediatric femur models. J Pediatr Orthop 2012; 32 (5) 461-466
- 39 Kaiser MM, Zachert G, Wendlandt R , et al. Biomechanical analysis of a synthetic femoral spiral fracture model: Do end caps improve retrograde flexible intramedullary nail fixation?. J Orthop Surg 2011; 6: 46
- 40 Kaiser MM, Wessel LM, Zachert G , et al. Biomechanical analysis of a synthetic femur spiral fracture model: Influence of different materials on the stiffness in flexible intramedullary nailing. Clin Biomech (Bristol, Avon) 2011; 26 (6) 592-597
- 41 Kaiser MM, Zachert G, Wendlandt R , et al. Increasing stability by pre-bending the nails in elastic stable intramedullary nailing: a biomechanical analysis of a synthetic femoral spiral fracture model. J Bone Joint Surg Br 2012; 94 (5) 713-718
- 42 Miller DJ, Kelly DM, Spence DD, Beaty JH, Warner Jr WC, Sawyer JR. Locked intramedullary nailing in the treatment of femoral shaft fractures in children younger than 12 years of age: indications and preliminary report of outcomes. J Pediatr Orthop 2012; 32 (8) 777-780
- 43 MacNeil JA, Francis A, El-Hawary R. A systematic review of rigid, locked, intramedullary nail insertion sites and avascular necrosis of the femoral head in the skeletally immature. J Pediatr Orthop 2011; 31 (4) 377-380
- 44 González-Herranz P, Burgos-Flores J, Rapariz JM, Lopez-Mondejar JA, Ocete JG, Amaya S. Intramedullary nailing of the femur in children. Effects on its proximal end. J Bone Joint Surg Br 1995; 77 (2) 262-266
- 45 Keeler KA, Dart B, Luhmann SJ , et al. Antegrade intramedullary nailing of pediatric femoral fractures using an interlocking pediatric femoral nail and a lateral trochanteric entry point. J Pediatr Orthop 2009; 29 (4) 345-351
- 46 Abdelgawad AA, Sieg RN, Laughlin MD, Shunia J, Kanlic EM. Submuscular bridge plating for complex pediatric femur fractures is reliable. Clin Orthop Relat Res 2013; 471 (9) 2797-2807
- 47 Wilson CH, Smith CS, Gay DM, Loveless EA. Submuscular locked plating of pediatric femur fractures. J Surg Orthop Adv 2012; 21 (3) 136-140
- 48 Simanovsky N, Porat S, Simanovsky N, Eylon S. Close reduction and intramedullary flexible titanium nails fixation of femoral shaft fractures in children under 5 years of age. J Pediatr Orthop B 2006; 15 (4) 293-297
- 49 Setter KJ, Palomino KE. Pediatric tibia fractures: current concepts. Curr Opin Pediatr 2006; 18 (1) 30-35
- 50 Myers SH, Spiegel D, Flynn JM. External fixation of high-energy tibia fractures. J Pediatr Orthop 2007; 27 (5) 537-539
- 51 Kubiak EN, Egol KA, Scher D, Wasserman B, Feldman D, Koval KJ. Operative treatment of tibial fractures in children: are elastic stable intramedullary nails an improvement over external fixation?. J Bone Joint Surg Am 2005; 87 (8) 1761-1768
- 52 Bienkowski P, Harvey EJ, Reindl R, Berry GK, Benaroch TE, Ouellet JA. The locked flexible intramedullary humerus nail in pediatric femur and tibia shaft fractures: a feasibility study. J Pediatr Orthop 2004; 24 (6) 634-637
- 53 Rana AR, Michalsky MP, Teich S, Groner JI, Caniano DA, Schuster DP. Childhood obesity: a risk factor for injuries observed at a level-1 trauma center. J Pediatr Surg 2009; 44 (8) 1601-1605
- 54 Griffet J, Leroux J, Boudjouraf N, Abou-Daher A, El Hayek T. Elastic stable intramedullary nailing of tibial shaft fractures in children. J Child Orthop 2011; 5 (4) 297-304
- 55 Lascombes P, Haumont T, Journeau P. Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop 2006; 26 (6) 827-834
- 56 Mashru RP, Herman MJ, Pizzutillo PD. Tibial shaft fractures in children and adolescents. J Am Acad Orthop Surg 2005; 13 (5) 345-352
- 57 Pandya NK, Edmonds EW. Immediate intramedullary flexible nailing of open pediatric tibial shaft fractures. J Pediatr Orthop 2012; 32 (8) 770-776
- 58 Grottkau BE, Epps HR, Di Scala C. Compartment syndrome in children and adolescents. J Pediatr Surg 2005; 40 (4) 678-682
- 59 Pandya NK, Edmonds EW, Mubarak SJ. The incidence of compartment syndrome after flexible nailing of pediatric tibial shaft fractures. J Child Orthop 2011; 5 (6) 439-447