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Method and Instrumented Fixture for Femoral Fracture Testing in a Sideways Fall-on-the-Hip Position
Published on: August 17, 2017
Treatments for paediatric femoral fractures: a randomised trial
James G Wright1, Elaine E L Wang, Janice L Owen
1Division of Orthopaedic Surgery, Hospital for Sick Children, Toronto, ON, Canada. james.wright@sickkids.ca
Insights
External fixation is a more effective treatment for paediatric femoral fractures than hip spica casting, significantly reducing malunion rates. Both treatments showed similar functional outcomes and patient satisfaction.
Area of Science:
- Orthopaedic surgery
- Paediatric orthopaedics
- Trauma surgery
Background:
- Paediatric femoral fractures have varied treatment approaches with limited evidence.
- A multicentre randomised trial was conducted to compare treatment outcomes.
Purpose of the Study:
- To compare malunion rates between external fixation and early hip spica cast application for paediatric femoral shaft fractures.
Main Methods:
- Children aged 4-10 years with femoral fractures were randomly assigned to either hip spica or external fixation.
- The primary outcome was malunion at 2 years, with secondary outcomes including functional scores and satisfaction ratings.
Main Results:
- Malunion rates were significantly higher in the hip spica group (45%) compared to the external fixator group (16%).
- No significant differences were observed in physical function, behavioural scores, or satisfaction between the groups.
Conclusions:
- Early hip spica casting has a limited role in treating paediatric femoral fractures due to higher malunion rates.
- Future research should investigate external fixation against flexible intramedullary nails.
Background:
Treatments for femoral fractures in children vary widely and have been investigated only in case series. We did a multicentre randomised trial to compare malunion rates after external fixation and after early application of a hip spica cast for paediatric femoral shaft fractures.
Methods:
All children aged 4-10 years with femoral fractures, admitted to four paediatric hospitals, were randomly assigned early application of hip spica or external fixation. The primary outcome was malunion at 2 years after the fracture. Secondary outcomes were scores on the RAND physical function child health questionnaire and the post-hospitalisation behavioural questionnaire, and parents' and children's ratings of overall satisfaction with treatment. Analysis was by intention to treat based on children who reached the 2 year evaluation.
Findings:
Of 60 children assigned to the hip-spica group, 56 reached the 2-year assessment; of them, six (11%) required other forms of treatment because of unacceptable loss of reduction. Of 48 children assigned external fixation, 45 reached the 2-year assessment; two (4%) had refractures and five (11%) required operative adjustment of the fixator. The rate of malunion was significantly higher in the hip-spica group than in the external-fixator group (25/56 [45%] vs 7/45 [16%]; 95% CI for difference 12-46%; p=0.002). The two groups had similar mean scores for the RAND physical function health questionnaire (0.34 vs 0.45; 95% CI for difference, -0.57 to 0.34; p=0.61), for the post-hospitalisation questionnaire (106.8 vs 106.3; -4.9 to 5.9; p=0.86), and for parents' satisfaction (4.3 vs 4.2; -0.3 to 0.6; p=0.5) and children's ratings of happiness with treatment (6.9 vs 7.7; -2.2 to 0.5; p=0.21).
Interpretation:
Early application of hip spica has a small role in the treatment of paediatric femoral fractures. Future trials need to compare external fixation with flexible intramedullary nails.
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