Eksternal Fiksasyon Pediatrik Femur Kırıklarında Etkili Bir Tedavi Metodu mudur?

Year 2015, Volume: 12 Issue: 1, 16 - 22, 15.04.2015

Mustafa Isik , Burcin Karsli , Vahap Saricicek Fethi Bilgin Abbas Kaya

Abstract

Amaç: Pediatrik femur kırıkları acil servislerde karşılaşılan kırıkların önemli bir bölümünü oluşturmaktadır.
Tedavi seçenekleri arasında konservatif yöntemler ve cerrahi yöntemler bulunmaktadır. Açılanma,
malrotasyon ve kısalık gibi farklı sorunlar her iki tedavi yönteminde de görülebilir.
Metot: Bu çalışmada son beş yıl içinde eksternal fiksasyonla tedavi edilen 22 pediatrik femur kırıklı hasta
retrospektif olarak değerlendirilip, eksternal fiksatör tedavisinin avantajları ve dezavantajları incelenmiştir.
Bulgular: Çalışmada elde edilen sonuçlar tatmin edici idi. Eksternal fiksatör uygulaması kolay ve hızlı bir
yöntemdir.
Sonuç: Bazı dezavantajlarına rağmen, hastanede kalış süresinin kısa olması, erken mobilizasyon, aile
bakımı, çocuk ve aile uyumu, kısa sürede okula geri dönebilme ve maliyet etkin bir yöntem olması gibi
nedenlerle çocuk femur kırıklarında ilk planda uygulanabilir bir tedavi yöntemi olabilir. 

Keywords

Eksternal Fiksasyon, Femur, Kapalı Kırıklar, Çocuk

Is External Fixation Effective in Pediatric Femur Fractures?

Abstract

Backgrounds: Pediatric femur fractures comprise a major portion of fractures that are repaired in emergency
rooms. Treatment options include conservative methods, and surgical methods. Different problems such as
angulation, malrotation and shortening may be observed both treatment methods.
Methods: In this study twenty-two pediatric femoral fractures which treated with external fixators in past
five years were evaluated retrospectively. Advantages, and disadvantages of external fixation were
investigated.
Results: Results were satisfactory. In conclusion, external fixator application is an easy to perform and quick
method.
Conclusions: Despite some disadvantages, it may be one of the treatment methods that should be considered
in the first plan in pediatric femoral fractures due to reasons such as short length of hospital stay, early
mobilization, ease of family care, rapid child and family compliance, early return to school, and reduced
treatment costs. 

Keywords

External Fixation, Femur, Closed Fractures, Child

References

• 1) Heyworth BE, Galano GJ, Vitale MA, Vitale MG. Management of closed femoral shaft fractures in children, ages 6 to 10: national practice patterns and emerging trends. J Pediatr Orthop 2004; 24(5):455-9. 2) Galano GJ, Vitale MA, Kessler MW, Hyman JE, Vitale MG. The most frequent traumatic orthopaedic injuries from a national pediatric inpatient population. J Pediatr Orthop 2005; 25(1):39-44. 3) Loder RT, O'Donnell PW, Feinberg JR. Epidemiology and mechanisms of femur fractures in children. J Pediatr Orthop 2006; 26(5):561-6. 4) Weinberg A.M, Leitner A, Lampert C, Laer L. External Fixation of Pediatric Femoral Shaft Fractures: Treatment and Results of 121 Fractures. European Journal of Trauma 2000; 26:25-32. 5) Domb BG, Sponseller PD, Ain M, Miller NH. Comparison of dynamic versus static external fixation for pediatric femur fractures. J Pediatr Orthop 2002; 22(4):428-30. 6) Canale, S.T. and V.T. Tolo, Fractures of the femur in children. Instr Course Lect 1995; 255-73. 7) McCartney D, Hinton A, Heinrich SD. Operative stabilization of pediatric femur fractures. Orthop Clin North Am 1994; 25(4):635-50. 8) Kasser, J.R. Femur fractures in children. Instr Course Lect 1992; 403-8. 9) Guttmann GG, Simon R. Three-point fixation walking spica cast: an alternative to early or immediate casting of femoral shaft fractures in children. J Pediatr Orthop 1988; 8(6):699-703. 10) Herndon WA, Mahnken RF, Yngve DA, Sullivan JA. Management of femoral shaft fractures in the adolescent. J Pediatr Orthop 1989; 9(1):29-32. 11) Yandow SM, Archibeck MJ, Stevens PM, Shultz R. Femoral-shaft fractures in children: a comparison of immediate casting and traction. J Pediatr Orthop 1999; 19(1):55-9. 12) Aronson DD, Singer RM, Higgins RF. Skeletal traction for fractures of the femoral shaft in children. A long-term study. J Bone Joint Surg Am 1987; 69(9):1435-9. 13) Beaty, J.H. Femoral-Shaft Fractures in Children and Adolescents. J Am Acad Orthop Surg 1995; 3(4):207- 217. 14) Aronson J, Tursky EA. External fixation of femur fractures in children. J Pediatr Orthop 1992; 12(2):157- 63. 15) Evanoff M, Strong ML, MacIntosh R. External fixation maintained until fracture consolidation in the skeletally immature. J Pediatr Orthop 1993; 13(1):98- 101. 16) Gregory RJ, Cubison TC, Pinder IM, Smith SR. External fixation of lower limb fractures in children. J Trauma 1992; 33(5):691-3. 17) Miner T, Carroll KL. Outcomes of external fixation of pediatric femoral shaft fractures. J Pediatr Orthop 2000; 20(3):405-10. 18) Ogden, J.A. Skeletal injury in the child. 2nd ed. Philadelphia, 1990; 930. 19) Wall EJ, Jain V, Vora V, Mehlman CT, Crawford AH. Complications of titanium and stainless steel elastic nail fixation of pediatric femoral fractures. J Bone Joint Surg Am 2008; 90(6):1305-13. 20) Newton PO, Mubarak SJ. Financial aspects of femoral shaft fracture treatment in children and adolescents. J Pediatr Orthop 1994; 14(4):508-12. 21) Probe R, Lindsey RW, Hadley NA, Barnes DA. Refracture of adolescent femoral shaft fractures: a complication of external fixation. A report of two cases. J Pediatr Orthop 1993; 13(1):102-5. 22) Chung SM. The arterial supply of the developing proximal end of the human femur. J Bone Joint Surg Am 1976; 58(7): 961-70. 23) Kesemenli CC, Subasi M, Kirkgöz T, Necmioglu S, Kapukaya A. Comparison of external fixation and pelvipedal cast treatments in closed femur diaphysis fractures in children. Acta Orthop Travmatol Turc 2000; 34(34):40-44. 24) Blasier RD, Aronson J, Tursky EA. External fixation of pediatric femur fractures. J Pediatr Orthop 1997; 17(3):342-6. 25) Kapukaya A, Subaşi M, Necmioğlu S, Arslan H, Kesemenli C, Yildirim K. Treatment of closed femoral diaphyseal fractures with external fixators in children. Arch Orthop Trauma Surg 1998; 117(6-7):387-9. 26) Alonso JE, Horowitz M. Use of the AO/ASIF external fixator in children. J Pediatr Orthop 1987; 7(5):594-600. 27) Kirschenbaum D, Albert MC, Robertson WW Jr, Davidson RS. Complex femur fractures in children: treatment with external fixation. J Pediatr Orthop 1990; 10(5):588-91. 28) Robertson P, Karol LA, Rab GT. Open fractures of the tibia and femur in children. J Pediatr Orthop 1996; 16(5):621-6. 29) De Sanctis N, Gambardella A, Pempinello C, Mallano P, Della Corte S. The use of external fixators in femur fractures in children. J Pediatr Orthop 1996; 16(5):613- 20. 30) Kesemenli CC, Subasi M, Arslan H, Tüzüner T, Necmioglu S, Kapukaya A. Is external fixation in pediatric femoral fractures a risk factor for refracture? J Pediatr Orthop 2004; 24(1):17-20. 31) Hull JB, Bell MJ. Modern trends for external fixation of fractures in children: a critical review. J Pediatr Orthop B 1997; 6(2):103-9. 32) Van Tets WF, van der Werken C. External fixation for diaphyseal femoral fractures: a benefit to the young child? Injury 1992; 23(3):162-4. 33) Platz A, Käch K. Management of unstable shaft fractures of the lower extremity in children using the external fixator. Swiss Surg 1996; 2(2):284-289. 34) Greene WB. Displaced fractures of the femoral shaft in children. Unique features and therapeutic options. Clin Orthop Relat Res 1998; 353:86-96. 35) Ligier JN, Metaizeau JP, Prévot J, Lascombes P. Elastic stable intramedullary pinning of long bone shaft fractures in children. Z Kinderchir 1985; 40(4): 209-12. 36) Malkawi H, Shannak A, Hadidi S. Remodeling after femoral shaft fractures in children treated by the modified blount method. J Pediatr Orthop 1986; 6(4):421-9. 37) Hedin H, Hjorth K, Rehnberg L, Larsson S. External fixation of displaced femoral shaft fractures in children: a consecutive study of 98 fractures. J Orthop Trauma 2003; 17(4):250-6. 38) Schmittenbecher PP. Standardindikation zur intramedullaren Osteosynthese im Wachstumsalter. Erfahrungen bei 100 Patienten. Akt Chir 1995; 30(30):171- 179. 39) Krettek C, Haas N, Walker J, Tscherne H. Treatment of femoral shaft fractures in children by external fixation. Injury 1991; 22(4):263-6. 40) Tolo VT. External fixation in multiply injured children. Orthop Clin North Am 1990; 21(2): 393-400. 41) Klein W, Pennig D, Brug E. Use of unilateral external fixation in pediatric femur shaft fracture within the scope of polytrauma. Unfallchirurg, 1989; 92(6):282-6. 42) Wallace ME, Hoffman EB. Remodelling of angular deformity after femoral shaft fractures in children. J Bone Joint Surg Br 1992; 74(5):765-9.