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External fixation of lower limb fractures in children
R J Gregory1, T C Cubison, I M Pinder
1Department of Orthopaedic Surgery, Newcastle General Hospital, Newcastle Upon Tyne, England.
Insights
External fixation is a recommended treatment for pediatric tibial and femoral shaft fractures, especially in children with multiple injuries. This method demonstrated effective union rates with manageable pin track infection risks.
Area of Science:
- Orthopedic Surgery
- Pediatric Traumatology
- Biomedical Engineering
Background:
- Childhood fractures of the tibial and femoral shafts require effective treatment strategies.
- External fixation is an option for complex pediatric fractures, including those with associated injuries or failed conservative management.
Purpose of the Study:
- To evaluate the efficacy and outcomes of external fixation for treating tibial and femoral shaft fractures in children.
- To assess complication rates, specifically pin track infections, and union times associated with external fixation in pediatric patients.
Main Methods:
- Retrospective analysis of 34 tibial and femoral shaft fractures in 32 children (ages 3-15) treated with external fixation over 5 years.
- Indications included associated major injuries and failed conservative treatment.
- Data collected on union time and pin track infection rates.
Main Results:
- Successful union achieved at an average of 11.7 weeks for femoral and 10.0 weeks for tibial fractures.
- Overall pin track infection rate was 6%, with significantly lower rates for tibial pins (2.1%) compared to femoral pins (10.3%).
- One case of delayed union and one early refracture were noted.
Conclusions:
- External fixation is a recommended treatment for pediatric femoral and tibial shaft fractures.
- It is particularly beneficial for children with multiple injuries or when conservative methods fail.
- Careful pin site management is crucial, especially for femoral pins, to minimize infection risks.
Abstract:
Thirty-four tibial and femoral shaft fractures in 32 children between the ages of 3 and 15 years were treated by external fixation over a 5-year period. The indications were fractures occurring in association with other major injuries and failure of conservative treatment to maintain satisfactory reduction. There was one case of delayed union and one early refracture. The overall pin track infection rate was 6%, but the rate for the tibial pins (2.1%) was much lower than for the femoral pins (10.3%). Union was achieved at an average of 11.7 weeks in the femoral fractures and 10.0 weeks in the tibial fractures. The use of external fixation is recommended for childhood femoral and tibial fractures, particularly in children with multiple injuries.