| Immediate incorporated hip spica casting in pediatric femoral fractures: comparison of efficacy between normal and high-risk groups. | |
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MedLine Citation:
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PMID: 19098644 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Ertuğrul Akşahin; Levent Celebi; Halil Yalçin Yüksel; Onur Hapa; Hasan Hilmi Muratli; Cem Nuri Aktekin; Ali Biçimoğlu |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Journal of pediatric orthopedics Volume: 29 ISSN: 1539-2570 ISO Abbreviation: J Pediatr Orthop Publication Date: 2009 Jan-Feb |
Date Detail:
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Created Date: 2008-12-22 Completed Date: 2009-02-23 Revised Date: 2010-09-28 |
Medline Journal Info:
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Nlm Unique ID: 8109053 Medline TA: J Pediatr Orthop Country: United States |
Other Details:
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Languages: eng Pagination: 39-43 Citation Subset: IM |
Affiliation:
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Ankara Numune Education and Research Hospital, Ankara, Turkey. ertugrul_aksahin@hotmail.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Bone Nails Casts, Surgical / adverse effects* Child Child, Preschool Female Femoral Fractures / surgery* Follow-Up Studies Fractures, Malunited / etiology, radiography Humans Infant Leg Length Inequality / etiology*, radiography Male Postoperative Complications / etiology* Risk Factors Traction / methods Treatment Outcome |
| Comments/Corrections | |
Comment In:
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J Pediatr Orthop. 2010 Oct-Nov;30(7):e5
[PMID:
20864843
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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