Document Detail

Immediate incorporated hip spica casting in pediatric femoral fractures: comparison of efficacy between normal and high-risk groups.
MedLine Citation:
PMID:  19098644     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Immediate hip spica casting is the most commonly used method for the treatment of pediatric femoral fractures. The main disadvantage of the method is the unacceptable shortening (>25 mm), which may occur during the treatment. Buehler et al described the so-called telescope test to identify the cases with a relatively high risk of unacceptable shortening. On the basis of this test, patients with an overriding of the fracture ends of more than 30 mm have a 20.4 times higher risk of unacceptable shortening compared with those with an overriding of less than 30 mm. This relatively higher risk of unacceptable shortening may be avoided by a hip spica cast, which is incorporated to a distal femoral traction pin. METHODS: The study consists of 47 (26 boys and 21 girls) patients. Mean age was 40.3 months (range, 18 months to 6 years). Patients were divided into 2 groups according to the telescope test. Group 1 included patients with telescope test results of more than 30 mm. Group 2 included patients with telescope test results of 30 mm or less. All patients were treated with a hip spica cast, which is incorporated to a distal femoral traction pin within 8 hours of the initial trauma. During cast treatment, patients were followed up by weekly x-ray controls for the first month. Patients were assessed for unacceptable shortening and misalignment. RESULTS: Mean (SD) shortening during cast treatment was 2.9 (5.1) mm on the treated site. Shortening was detected in 16 patients (88.9%) in group 1 and in 7 patients (24.1%) in group 2. A significantly higher number (P < 0.001) of patients developed shortening in group 1. However, unacceptable shortening (>25 mm) did not develop in any patient in both groups. There was no significant frontal plane malalignment in both groups (P > 0.05). Sagittal plane malalignment was significantly higher in group 1 (P < 0.05). CONCLUSIONS: Hip spica cast, which is incorporated to a distal femoral traction pin, avoids unacceptable shortening and frontal plane malalignment in pediatric femoral fractures, which even have a relatively high risk of unacceptable shortening based on the so-called telescope test. However, the technique cannot avoid sagittal malalignment.
Ertuğrul Akşahin; Levent Celebi; Halil Yalçin Yüksel; Onur Hapa; Hasan Hilmi Muratli; Cem Nuri Aktekin; Ali Biçimoğlu
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of pediatric orthopedics     Volume:  29     ISSN:  1539-2570     ISO Abbreviation:  J Pediatr Orthop     Publication Date:    2009 Jan-Feb
Date Detail:
Created Date:  2008-12-22     Completed Date:  2009-02-23     Revised Date:  2010-09-28    
Medline Journal Info:
Nlm Unique ID:  8109053     Medline TA:  J Pediatr Orthop     Country:  United States    
Other Details:
Languages:  eng     Pagination:  39-43     Citation Subset:  IM    
Ankara Numune Education and Research Hospital, Ankara, Turkey.
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MeSH Terms
Bone Nails
Casts, Surgical / adverse effects*
Child, Preschool
Femoral Fractures / surgery*
Follow-Up Studies
Fractures, Malunited / etiology,  radiography
Leg Length Inequality / etiology*,  radiography
Postoperative Complications / etiology*
Risk Factors
Traction / methods
Treatment Outcome
Comment In:
J Pediatr Orthop. 2010 Oct-Nov;30(7):e5   [PMID:  20864843 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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