Behavior of diaphyseal fractures of the femur in children
Abstract
Introduction: Fractures of the diaphysis of the femur in children, represent a health problem that requires the intervention of an orthopedist who applies various treatment modalities ranging from conservative to surgical.
Objective: To describe the epidemiological characteristics of a group of pediatric patients with this traumatic entity.
Methods: A descriptive observational study was carried out in 54 patients treated at the Dr. Eduardo Agramonte Piña Provincial Pediatric Hospital in the city of Camagüey from January 1st, 2018 to December 31st, 2022 with a total of 60 months.
Results: The male-female sex ratio of the 54 patients was 2.8 to 1, left-right femur 1.2 to 1. The average age in general was 8.1 years. The average hospital stay was 6 days. The middle third was affected in 57.4 % of the cases. The months of July and December together with the days of Tuesday and Sunday were the ones that presented the largest number of patients. The most used treatment was the placement of a plaster spike in 28 patients for 51.8%, rigid intramedullary nails were used in 16 patients and represented 29.6 %. On the other hand, flexible intramedullary nails were placed in 10 cases for 18.5%.
Conclusions: Femoral diaphysis fractures in children are more frequent in males, left side, in the middle third, with a transversal pattern. The months of the year with the highest incidence were July and December and on Tuesdays and Sundays. Treatment depends on age, weight, and configuration of the fracture.
DeCS: FEMORAL FRACTURES; FEMUR; DIAPHYSES; CHILD; CASTS, SURGICAL.
Downloads
References
1. Egol k, Koval KJ, Zuckerman JD. Handbook of Fractures. 6th ed. Philadelphia: Wolters Kluwer; 2020.
2. Baghdadi S, Mahmoud MAH, Flynn JJM, Arkader A. Unplanned Return to the Operating Room (UpROR) After Pediatric Diaphyseal Femoral Fractures. J Pediatr Orthop [Internet]. 2022 Feb [citado 18 Abr 2023]; 42(2): e120-e125. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34923506/
3. Ramo B, Ellis HB. Lower extremity injuries. En: Herring JA. Tachdjian's Pediatric Orthopaedics. 6ta ed. Philadelphia: Elsevier; 2022. p. 1316-1331.
4. Rehn A, Ngu A, Thair A. Flexible Intramedullary Nailing of femoral Shaft Fractures in Children Weighing=40 kg: A Systematic Review and Meta-Analysis. J Pediatr Orthop [Internet]. 2021 Jul [citado 18 Abr 2023];41(6): e479. Disponible en: https://journals.lww.com/pedorthopaedics/citation/2021/07000/flexible_intramedullary_nailing_of_femoral_shaft.31.aspx
5. Besomi J, Gordon E. Fracturas de la diáfisis de fémur. En: Sepúlveda Oviedo M, editor. Traumatología Infantil. Santiago de Chile: Universidad Austral; 2023.p.187-191.
6. Busch MT, Perkins CA, Nickel BT, Blizzard DJ, Willimon SC. A Quartet of Elastic Stable Intramedullary Nails for More Challenging Pediatric Femur Fractures. J Pediatr Orthop [Internet]. 2019 Ene [citado 18 Abr 2023]; 39(1): e12-e17. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30540656/
7. Naik P. Remodelling in Children's Fractures and Limits of Acceptability. Indian J Orthop [Internet]. 2021 Jun [citado 18 Abr 2023];55(3): 549-59. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8081818/
8. Kamienski MC. Pediatric Femur Fractures. Orthop Nurs [Internet]. 2020 Mar-Abr [citado 18 Abr 2023];39(2):107-11. Disponible en: https://journals.lww.com/orthopaedicnursing/abstract/2020/03000/pediatric_femur_fractures.7.aspx
9. Yigit S, Yildirim A. The surgery outcomes of pediatric femoral shaft fractures and comparision of radiation risks. Acta Biomed [Internet]. 2020 [citado 18 Abr 2023]; 91(2): 326-331. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569624/
10. Chen X, Lu M, Xu W, Wang X, Xue M, Dai J, et al. Treatment of pediatric femoral shaft fractures with elastic stable intramedullary nails versus external fixation: a meta-analysis. Orthop Traumatol Surg Res [Internet]. 2020 Nov [citado 18 Abr 2023]; 106(7): 1305-1311. Disponible en: https://www.sciencedirect.com/science/article/pii/S1877056820302553?via%3Dihub
11. Macha AP, Temu R, Olotu F, Seth NP, Massawe HL. Epidemiology and associated injuries in paediatric diaphyseal femur fractures treated at a limited resource zonal referral hospital in northern Tanzania. BMC Musculoskelet Disord [Internet]. 2022 Abr [citado 18 Abr 2023];23(1). Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9017012/
12. Sinha SK, Kumar V, Singh A. Outcomes of fracture shaft femur in pediatric population managed at emergency. J Clin Orthop Trauma [Internet]. 2017 Oct-Dic [citado 18 Abr 2023];8(4):313-319. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647623/
13. Liebs TR, Meßling A, Milosevic M, Berger SM, Ziebarth K. Health-related quality of Life after adolescent fractures of the femoral shaft stabilized by a lateral entry femoral nail. Children (Basel) [Internet]. 2022 Mar [citado 18 Abr 2023];9(3):327. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8947705/
14. Frei B, Mayr J, de Bernardis G, Camathias C, Holland-Cunz S, Rutz E. Elastic stable intramedullary nailing (ESIN) of diaphyseal femur fractures in children and adolescents: a strobe-compliant study. Medicine (Baltimore) [Internet]. 2019 Jun [citado 18 Abr 2023];98(14) e15085. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6456152/
15. Grauberger J, O'Byrne M, Stans AA, Shaughnessy WJ, Larson AN, Milbrandt TA. Does shorter time to treatment of pediatric femur shaft fractures impact clinical outcomes? J Pediatr Orthop [Internet]. 2020 Jul [citado 18 Abr 2023];40(6):e435-e439. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283976/
16. Aktas E, Ömeroglu H. Treatment preferences of orthopedic surgeons for closed, isolated middle-third diaphyseal long bone fractures without neurovascular injury in children: A cross- sectional survey. Acta Orthop Traumatol Turc [Internet]. 2022 May [citado 18 Abr 2023];56(3):194-8. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9612644/
17. Duffy S, Gelfer Y, Trompeter A, Clarke A, Monsell F. The clinical features, management options and complications of paediatric femoral fractures. Eur J Orthop Surg Traumatol [Internet]. 2021 [citado 18 Abr 2023];31(5):883-92. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233277/
18. Yap ST, Lee N, Ang ML, Chui RW, Lim K, Arjandas M, et al. Can paediatric femoral fracture hip spica application be done in the outpatient setting? Malays Orthop J [Internet]. 2021 Mar [citado 18 Abr 2023];15(1):105-12. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043651/
19. Del Balso C, Bartley D, Cashin M, Carey T, Lawendy AR. Rigid intramedullary nail fixation of traumatic femoral fractures in the skeletally immature. OTA Int [Internet]. 2021 Abr [citado 18 Abr 2023];4(2):e128. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8568442/
20. Magee LC, Mahmoud MAH, Baldwin K, Talwar D, Gandhi JS, Arkader A. Characteristics and hospital costs of spica cast treatment of non-accidental-related diaphyseal femoral fractures in children before walking age. J Pediatr Orthop [Internet]. 2020 Nov-Dic [citado 18 Abr 2023];40(10):e932-e935. Disponible en: https://doi.org/10.1097/BPO.0000000000001577
21. Greenhill DA, Herman MJ. Treatment of pediatric femoral shaft fractures. J Am Acad Orthop Surg [Internet]. 2022 Nov [citado 18 Abr 2023];30(22): e1443-e1452. Disponible en: https://journals.lww.com/jaaos/abstract/2022/11150/treatment_of_pediatric_femoral_shaft_fractures.9.aspx
22. Jardaly A, Hess M, Conklin M, Gilbert S. Webril-only soft spica cast for pediatric femoral fractures: a preliminary study. J Surg Orthop Adv [Internet]. 2021 [citado 18 Abr 2023];30(1):40-43. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33851913/
23. Mussell EA, Jardaly A, Gilbert SR. Length unstable femoral fractures: a misnomer? World J Orthop [Internet]. 2020 Sep [citado 18 Abr 2023];11(9):380-90. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507079/
24. Trottier ÉR, Hatcher L, Feng J, Camp M, Bouchard M. Incidence of secondary interventions after early spica casting for diaphyseal femur fractures in young children. Can J Surg [Internet]. 2022 Jul [citado 18 Abr 2023];65(4). Disponible en: https://www.canjsurg.ca/content/cjs/65/4/E417.full.pdf
25. Atassi O, Fontenot PB, Busel G, De La Fuente G, Donohue D, Maxson B, et al. Unstable pediatric femoral shaft fractures treated with flexible elastic nails have few complications. J Orthop Trauma. 2021 Feb;35(2):e56-e60. DOI: 10.1097/BOT.0000000000001886.
26. Benedick A, Bazar B, Zirkle LG, Liu RW. Retrograde intramedullary nailing of pediatric femoral shaft fractures does not result in growth arrest at the distal femoral physis-a retrospective cases series. J Orthop Trauma [Internet]. 2021 Nov [citado 18 Abr 2023];35(11):e405-e410. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33993174/
27. Donovan RL, Harries L, Whitehouse MR. Flexible nails have a significantly increased risk of complications compared with plating techniques when treating diaphyseal femoral fractures in children aged 5-12: a systematic review. Injury [Internet]. 2020 Dic [citado 18 Abr 2023];51(12):2763-70. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33039182/
28. Memeo A, Panuccio E, D'Amato RD, Colombo M, Boero S, Andreacchio A, et al. Retrospective, multicenter evaluation of complications in the treatment of diaphyseal femur fractures in pediatric patients. Injury [Internet]. 2019 Ago [citado 18 Abr 2023];50(Suppl 4):S60-S63. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30777296/
Published
How to Cite
Issue
Section
License
Copyright: Camagüey Medical Archive Magazine, offers immediately after being indexed in the SciELO Project; Open access to the full text of the articles under the principle of making available and free the research to promote the exchange of global knowledge and contribute to a greater extension, publication, evaluation and extensive use of the articles that can be used without purpose As long as reference is made to the primary source.
Conflicts of interest: authors must declare in a mandatory manner the presence or not of conflicts of interest in relation to the investigation presented.
(Download Statement of potential conflicts of interest)
The Revista Archivo Médico de Camagüey is under a License Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 International (CC BY 4.0).
This license allows others to distribute, to mix, to adjust and to build from its work, even for commercial purposes, as long as it is recognized the authorship of the original creation. This is the most helpful license offered. Recommended for maximum dissemination and use of licensed materials. The full license can be found at: https://creativecommons.org/licenses/
22 julio 2025