American Academy of Orthopaedic Surgeons
1999 Annual Meeting
Scientific Program

Femoral Fractures in Children and Adolescents: Consensus and Controversy

Moderator(s): James H. Beaty, MD, Memphis, TN

Monday, February 8, 1999
10:30 AM - 12:30 PM

Location: A1

SYMPOSIUM

James R Kasser, MD, Boston, MA
Scott J Mubarak, MD, San Diego, CA
Charles Turner Price, MD, Orlando, FL
William W Robertson Jr, MD, Washington, DC
John F Sarwark, MD, Chicago, IL


Femoral shaft fractures are relatively common injuries in children and adolescents. In children 6 to 10 years of age and in older adolescents, treatment indications for isolated femoral shaft fractures often overlap. Spica casting, external fixation, flexible intramedullary nailing, locked intramedullary nailing, and compression plating all have been recommended in various age groups, making treatment decisions difficult. Faculty with experience in each type of treatment will discuss indications and contraindications, advantages and disadvantages, technique pearls and pitfalls, outcome, complications, and cost analysis of the various methods. Emphasis will be on choosing the most appropriate treatment method for each individual patient.

  1. Outcomes, Cost Analysis and Femoral Fracture Management
    Scott J. Mubarak, MD, San Diego, CA
  2. Spica Casting for Femoral Fractures in Children: Selection, Technique, Complications
    John F. Sarwark, MD, Chicago, IL
  3. External Fixation of Femoral Fractures: Technique Tips, Complications
    Charles T. Price, MD, Orlando, FL (c - EBI, Inc.)
  4. Compression Plating of Femoral Fractures in Children and Adolescents
    William W. Robertson, Jr, MD, Washington DC
  5. Flexible IM Rods in Femoral Fractures: Technique, Results, Complications
    James R. Kasser, MD, Boston, MA
  6. IM Nailing of Femoral Fractures in Adolescents: Technique, Results, Complications
    James H. Beaty, MD, Memphis, TN

Case Presentations and Discussion

Outcomes, Cost Analysis and Femoral Fracture Management

Scott J. Mubarak, MD

Outcome must be assumed to be equal for financial analysis; however, all treatments will have different effects on patient, parents, and physicians.

Terminology

Who charges for their services ?

How much does it cost ?

What happens when the rules change ?

Spica Casting For Femoral Fractures In Children: Selection, Technique, Complications

John F. Sarwark, MD

Mechanism of injury

General treatment considerations

Assessment for early spica cast

Early spica cast (or traction + spica cast)

Evaluate under anesthesia

Protocol now: Discuss with parents, offer options

External Fixation of Femoral Fractures: Technique Tips, Complications

Charles T. Price, MD

Introduction

Management depends on

Cast immobilization for

Operative stabilization for

Telescope test - age 6 - 10 years

Alternatives to early spica

Advantages of external fixation

Problems with external fixation

Re-fracture

Callus fromation

Pin track management

Scars

When to use external fixation for femoral fractures

Compression Plating of Femoral Fractures in Children and Adolescents

William W. Robertson, Jr., MD

General

Treatment for children 8-12 years old - all can obtain good results

Primary indications for surgical treatment

Rigid internal or external fixation

Our study

Advantages of plate fixation

Flexible IM Rods in Femoral Fractures: Technique, Results, Complications

James R. Kasser, MD

The rod

Biomechanics of fixation

Technique

Postoperative management

Problems

Results

IM Nailing of Femoral Fractures in Adolescents: Technique, Results, Complications

James H. Beaty, MD

Advantages of locked IM nailing

Concerns

Anatomical considerations

Treatment considerations

Results and complications

Technique of antegrade IM nail insertion

Postoperative management

Pearls and pitfalls

Selected references

Beaty JH: Aseptic necrosis of the femoral head following antegrade nailing of femoral fractures in adolescents. Tech Orthop 1998; 13:96-99.

Beaty JH, Austin SM, Warner WC, Canale ST, Nichols L: Interlocking intramedullary nailing of femoral shaft fractures in adolescents: preliminary results and complications. J Pediatr Orthop 14:178, 1994.

Blaiser RD, Aronson J, Tursky EA: External fixation of pediatric femur fractures. J Pediatr Orthop 17:342, 1997.

Buehler KC, Thompson JD, Sponseller PD, et al: A prospective study of early spica casting outcomes in the treatment of femoral shaft fractures in children. J Pediatr Orthop 15:30, 1995.

Canale ST, Tolo VT: Fractures of the femur in children (Instr Course Lect). J Bone Joint Surg 77-A:294, 1995.

Carey TP, Galpin RD: Flexible intramedullary nail fixation of pediatric femoral fractures. Clin Orthop 332:110, 1996.

Erikkson E, Hovelius L: Ender nailing in fractures of the diaphysis of the femur. J Bone Joint Surg 61-A:1175, 1979.

Galpin RD, Willis RB, Sabano N: Intramedullary nailing of pediatric femoral fractures. J Pediatr Orthop 14:184, 1994.

Gregory P, Pevny T, Teague D: Early complications with external fixation of pediatric femoral shaft fractures. J Orthop Trauma 10:191, 1996.

Heinrich SD, et al: The operative stabilization of pediatric diaphyseal femur fractures with flexible intra- medullary nails: a prospective analysis. J Pediatr Orthop 14:501, 1994.

Hughes BF, Sponseller PD, Thompson JD: Pediatric femur fractures: effects of spica cast treatment on family and community. J Pediatr Orthop 15:461, 1995.

Ligier JN, Metaizeau JP, Prevot J, Lascombe P: Elastic stable intramedullary nailing of femoral shaft fractures in children. J Bone Joint Surg 70-B:74, 1988.

Martinez AG, Carroll NC, Sarwark JF, et al: Femoral shaft fractures in children treated with early spcia cast. J Pediatr Orthop 11:712, 1992.

McGraw JJ, Gregory SK: Ender nails: an alternative for intramedullary fixation of femoral shaft fracture in children and adolescents. South Med J 90:694, 1997.

Price CT, Levengood GA, Zink WP: The treatment of pediatric fractures with dynamic axial external fixation. Tech Orthop 4:74, 1989.

Reeves RB, Ballard RI, Hughes JL: Internal fixation versus traction and casting of adolescent femoral shaft fractures. J Pediatr Orthop 10:592, 1990.

Thometz JG, Lamdan R: Osteonecrosis of the femoral head after intramedullary nailing of a fracture of the femoral shaft in an adolescent: a case report. J Bone Joint Surg 77-A:1423, 1995.

Timmerman LA, Rab GT: Intramedullary nailing of femoral shaft fractures in adolescents. J Orthop Trauma 1993; 7:331-337.

Ward WT, Levy J, Kaye A: Compression plating for child and adolescent femur fractures. J Pediatr Orthop 12:626, 1992.


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