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Pediatric tibia and femur fractures in patients weighing more than 50 kg (110 lb): mini-review on current treatment options and outcome

  • A. Andreacchio
  • F. Alberghina
  • L. Marengo
  • F. Canavese
Review

Abstract

The main objective of this paper is to review the current literature on treatment of tibial and femur fractures in children and adolescents guided by body weight in patients weighing 50 kg (110 lb) or more. A secondary aim of this mini-review was to determine, as per literature review, whether weight  > 50 kg (110 lb) is an identifiable factor associated with increased complication rate. A search of the PubMed/MEDLINE, EMBASE and Cochrane Database of Systematic Reviews databases from 1954 to September 2017 was performed to identify papers related to pediatric tibia and femur fractures in children weighing more than 50 kg (110 lb). Abstracts were screened, and relevant full-text articles were retrieved for further review. Reference sections of identified papers were also screened to identify further literature. All levels of evidence were included. Overall, seven full-text articles dealing with pediatric tibia or femur fractures in patients weighing more than 50 kg (110 lb), and one article reporting on both femur and tibia fractures in this patients’ population, have been identified (n = 8 full-text article included). The articles reviewed a total of 679 children. In particular, 48/438 femur shaft fractures (mean weight: 51.7 kg or 113.9 lb) and 91/241 tibia fractures (mean weight: 53.3 kg or 117.5 lb) met the inclusion criteria. The overall rate of complications was 27.9%. In particular, the rate of complication was 51.7 and 29.6% in children with femur and tibia fracture weighing more than 50 kg (110 lb), respectively (p < 0.05). Elastic stable intramedullary nailing (ESIN) has become the treatment of choice for displaced tibia and femur shaft fractures in children between six and 12–15 years of age. Unstable fracture pattern, higher age and higher weight have been reported as potential risk factors associated with poor outcomes in children and adolescents treated with ESIN for displaced long bone fractures of the lower extremity, in particular femur shaft fractures. Despite these findings, data reporting exclusively on ESIN-treated long bone fractures in children weighing 50 kg (110 lb) or more remain scant.

Keywords

Tibial shaft fractures Femur shaft fractures Overweight Children Elastic stable intramedullary nailing 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    World Health Organization (2012) Population-based approaches to childhood obesity prevention. Publications of the World Health Organization, Geneva, pp 13–15. http://www.who.int
  2. 2.
    Lazar-Antman MA, Leet AI (2012) Effects of obesity on pediatric fracture care and management. J Bone Joint Surg Am 94(9):855–861CrossRefGoogle Scholar
  3. 3.
    Sabharwal S, Root MZ (2012) Impact of obesity on orthopaedics. J Bone Joint Surg Am 94(11):1045–1052CrossRefGoogle Scholar
  4. 4.
    Parratte S, Pesenti S, Argenson JN (2014) Obesity in orthopedics and trauma surgery. Orthop Traumatol Surg Res 100(1 Suppl):S91–S97.  https://doi.org/10.1016/j.otsr.2013.11.003 CrossRefPubMedGoogle Scholar
  5. 5.
    Carey TP, Galpin RD (1996) Flexible intramedullary nail fixation of pediatric femoral fractures. Clin Orthop Relat Res 332:110–118CrossRefGoogle Scholar
  6. 6.
    Brousil J, Hunter JB (2013) Femoral fractures in children. Curr Opin Pediatr 25:52–57CrossRefGoogle Scholar
  7. 7.
    Weiss JM, Choi P, Ghatan C, Skaggs DL, Kay RM (2009) Complications with flexible nailing of femur fractures more than double with child obesity and weight > 50 kg. J Child Orthop 3:53–58CrossRefGoogle Scholar
  8. 8.
    Leet AI, Pichard CP, Ain MC (2005) Surgical treatment of femoral fractures in obese children: does excessive body weight increase the rate of complications? J Bone Joint Surg Am 87:2609–2613PubMedGoogle Scholar
  9. 9.
    Setzer N, Saade E (2007) Childhood obesity and anesthetic morbidity. Paediatr Anaesth 17(4):321–326CrossRefGoogle Scholar
  10. 10.
    Backstrom IC, MacLennan PA, Sawyer JR, Creek AT, Rue LW, Gilbert SR (2012) Pediatric obesity and traumatic lower-extremity long-bone fracture outcomes. J Trauma Acute Care Surg 73:966–971CrossRefGoogle Scholar
  11. 11.
    Taylor ED, Theim KR, Mirch MC, Ghorbani S, Tanofsky-Kraff M, Adler-Wailes DC et al (2006) Orthopedic complications of overweight in children and adolescents. Pediatrics 117(6):2167–2174CrossRefGoogle Scholar
  12. 12.
    Hinton RY, Lincoln A, Crockett MM, Sponseller P, Smith G (1999) Fractures of the femoral shaft in children. Incidence, mechanisms, and sociodemographic risk factors. J Bone Joint Surg Am 81(4):500–509CrossRefGoogle Scholar
  13. 13.
    Loder RT, O’Donnell PW, Feinberg JR (2006) Epidemiology and mechanisms of femur fractures in children. J Pediatr Orthop 26(5):561CrossRefGoogle Scholar
  14. 14.
    Flynn JM, Shaggs DL, Waters PM (2015) Rockwood & Wilkins’ fractures in children, 8th edn. Wolters Kluwer Health, Philadelphia, pp 1137–1138Google Scholar
  15. 15.
    Moroz LA, Launay F, Kocher MS, Newton PO, Rick S, Sponseller PD et al (2006) Titanium elastic nailing of fractures of the femur in children. Predictors of complications and poor outcome. J Bone Joint Surg (Br) 88:1361–1366CrossRefGoogle Scholar
  16. 16.
    Narayanan UG, Phillips JH (2012) Flexibility in fixation: an update on femur fractures in children. J Pediatr Orthop 32(Suppl 1):S32–S39CrossRefGoogle Scholar
  17. 17.
    Flynn JM, Luedtke LM, Ganley TJ, Dawson J, Davidson RS, Dormans JP et al (2004) Comparison of titanium elastic nails with traction and a spica cast to treat femoral fractures in children. J Bone Joint Surg Am 86-A:770–777CrossRefGoogle Scholar
  18. 18.
    Abdelgawad AA, Sieg RN, Laughlin MD, Shunia J, Kanlic EM (2013) Submuscular bridge plating for complex pediatric femur fractures is reliable. Clin Orthop Relat Res 471:2797–2807CrossRefGoogle Scholar
  19. 19.
    Deakin DE, Winter H, Jain P, Bache CE (2010) Malunion following flexible intramedullary nails for tibial and femoral fractures in adolescents. J Child Orthop 4:571–577CrossRefGoogle Scholar
  20. 20.
    Canavese F, Marengo L, Andreacchio A, Mansour M, Paonessa M, Rousset M et al (2016) Complications of elastic stable intramedullary nailing of femoral shaft fractures in children weighing fifty kilograms (one hundred and ten pounds) and more. Int Orthop 40(12):2627–2634CrossRefGoogle Scholar
  21. 21.
    Marengo L, Paonessa M, Andreacchio A, Dimeglio A, Potenza A, Canavese F (2016) Displaced tibia shaft fractures in children treated by elastic stable intramedullary nailing: results and complications in children weighing 50 kg (110 lb) or more. Eur J Orthop Surg Traumatol 26:311–317CrossRefGoogle Scholar
  22. 22.
    Sankar WN, Jones KJ, Horn RD, Wells L (2010) Titanium elastic nails for pediatric tibial shaft fractures. J Child Orthop 1:281–286CrossRefGoogle Scholar
  23. 23.
    Goodbody MC, Lee RJ, Flynn JM, Sankar WN (2016) Titanium elastic nailing for pediatric tibia fractures: do older, heavier kids do worse? J Pediatr Orthop 36:472–477CrossRefGoogle Scholar
  24. 24.
    Wang Y, Lobstein T (2006) Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 1:11–25CrossRefGoogle Scholar
  25. 25.
    Hunter JB (2005) The principles of elastic stable intramedullary nailing in children. Injury 36(Suppl 1):A20–A24CrossRefGoogle Scholar
  26. 26.
    Wang Y, Lim H (2012) The global childhood obesity epidemic and the association between socio-economic status and childhood obesity. Int Rev Psychiatry 24:176–188CrossRefGoogle Scholar
  27. 27.
    Ho CA, Skaggs DL, Tang CV, Kay RM (2006) Use of flexible intramedullary nails in pediatric femur fractures. J Pediatr Orthop 26:497–504CrossRefGoogle Scholar
  28. 28.
    Kubiak EN, Egol KA, Scher D, Wasserman B, Feldman D, Kovac KJ (2005) Operative treatment of tibial fractures in children: are elastic stable intramedullary nails an improvement over external fixation? J Bone Joint Surg Am 87:1761–1768PubMedGoogle Scholar
  29. 29.
    Swindells MG, Rajan RA (2010) Elastic intramedullary nailing in unstable fractures of the paediatric tibial diaphysis: a systematic review. J Child Orthop 4:45–51CrossRefGoogle Scholar
  30. 30.
    Canavese F, Botnari A, Andreacchio A, Marengo L, Samba A, Dimeglio A et al (2016) Displaced tibial shaft fractures with intact fibula in children: nonoperative management versus operative treatment with elastic stable intramedullary nailing. J Pediatr Orthop 36(7):667–672CrossRefGoogle Scholar
  31. 31.
    Ramseier LE, Janicki JA, Weir S, Narayanan UG (2010) Femoral fractures in adolescents: a comparison of four methods of fixation. J Bone Joint Surg Am 92:1122–1129CrossRefGoogle Scholar
  32. 32.
    Shaha J, Cage JM, Black S, Wimberly RL, Shaha SH, Riccio AI (2018) Flexible intramedullary nails for femur fractures in pediatric patients heavier than 100 pounds. J Pediatr Orthop 38(2):88–93CrossRefGoogle Scholar
  33. 33.
    Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R et al (2000) CDC growth charts: United States. Adv Data 314:1–27Google Scholar
  34. 34.
    Lascombes P, Huber H, Fay R, Popkov D, Haumont T, Journeau P (2013) Flexible intramedullary nailing in children: nail to medullary canal diameters optimal ratio. J Pediatr Orthop 33:403–408CrossRefGoogle Scholar
  35. 35.
    Griffet J, Leroux J, Nouar Boudjouraf N, Abou-Daher A, El Hayek T (2011) Elastic stable intramedullary nailing of tibial shaft fractures in children. J Child Orthop 5:297–304CrossRefGoogle Scholar
  36. 36.
    Kinney MC, Nagle D, Bastrom T, Linn MS, Schwartz AK, Pennock AT (2016) Operative versus conservative management of displaced tibial shaft fracture in adolescents. J Pediatr Orthop 36(7):661–666CrossRefGoogle Scholar
  37. 37.
    Bar-On E, Sagiv S, Porat S (1997) External fixation or flexible intramedullary nailing for femoral shaft fractures in children. J Bone Joint Surg (Br) 79:975–978CrossRefGoogle Scholar
  38. 38.
    Ligier JN, Métaizeau JP, Prévot J (1983) Closed flexible medullary nailing in pediatric traumatololgy. Chir Pediatr 24:383–385PubMedGoogle Scholar
  39. 39.
    Pandya NK, Edmonds EW, Mubarak SJ (2011) The incidence of compartment syndrome after flexible nailing of pediatric tibial shaft fractures. Child Orthop 5:439–447CrossRefGoogle Scholar
  40. 40.
    Gordon JE, Gregush RV, Shoenecker PL, Dobbs MB, Luhmann SJ (2007) Complications after titanium elastic nailing of pediatric tibial fractures. J Pediatr Orthop 27:442–446CrossRefGoogle Scholar
  41. 41.
    Herman MJ, Martinek MA, Abzug JM (2014) Complications of tibial eminence and diaphyseal fractures in children: prevention and treatment. J Am Acad Orthop Surg 22(11):730–741CrossRefGoogle Scholar
  42. 42.
    Lascombes P, Haumont T, Journeau P (2006) Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop 26(6):827–834CrossRefGoogle Scholar
  43. 43.
    Luhmann SJ, Schootman M, Schoenecker PL, Dobbs MB, Gordon JE (2003) Complications of titanium elastic nails for pediatric femoral shaft fractures. J Pediatr Orthop 23:443–447PubMedGoogle Scholar
  44. 44.
    Fedorak GT, Cuomo AV, Otsuka NY (2015) Does pediatric body mass index affect surgical outcomes of lower-extremity external fixation? J Pediatr Orthop 35(4):391–394CrossRefGoogle Scholar
  45. 45.
    Kong H, Sabharwal S (2014) External fixation for closed pediatric femoral shaft fractures: where are we now? Clin Orthop Relat Res 472(12):3814–3822CrossRefGoogle Scholar
  46. 46.
    Andreacchio A, Marengo L, Canavese F, Pedretti L, Memeo A (2016) Comparison between external fixation and elastic stable intramedullary nailing for the treatment of femoral shaft fractures in children younger than 8 years of age. J Pediatr Orthop B 25(5):471–477CrossRefGoogle Scholar
  47. 47.
    Kocher MS, Sink EL, Blasier RD, Luhmann SJ, Mehlman CT, Scher DM et al (2009) Treatment of pediatric diaphyseal femur fractures. J Am Acad Orthop Surg 17:718–725CrossRefGoogle Scholar

Copyright information

© Istituto Ortopedico Rizzoli 2018

Authors and Affiliations

  1. 1.Department of Pediatric Orthopaedic SurgeryRegina Margherita Children’s HospitalTurinItaly
  2. 2.Department of Pediatric SurgeryUniversity Hospital EstaingClermont-FerrandFrance

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