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Implant-related fractures in children: a 15-year review
Amit Jain1, Gurkan Erkula, Arabella I Leet
1Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD 21224-2780, USA.
Insights
Pediatric implant-related fractures are rare, with the femur being the most common site. Preoperative diagnoses like cerebral palsy significantly increase fracture risk, influencing implant removal decisions.
Area of Science:
- Pediatric Orthopedics
- Biomedical Engineering
- Clinical Study
Background:
- No comprehensive clinical studies on pediatric implant-related fractures exist.
- This study aimed to identify the incidence, skeletal location, and associated diagnoses of these fractures.
Purpose of the Study:
- To determine the incidence and patterns of implant-related fractures in children.
- To identify risk factors, including skeletal location and preoperative diagnoses.
Main Methods:
- Retrospective review of 7584 pediatric implant insertions (1995-2009).
- Calculation of fracture incidence stratified by skeletal location and diagnosis.
- Statistical analysis using Fisher exact test and risk ratios (P<0.05).
Main Results:
- Overall incidence of implant-related fracture was 0.33%, with the femur being most affected (0.89%).
- Cerebral palsy, hip dysplasia, and spina bifida were associated with higher fracture risks (6.1 times).
- The mean time to fracture was 2.8 years; implant removal rates varied by diagnosis.
Conclusions:
- Skeletal location and preoperative diagnosis are critical factors in managing pediatric implants.
- Consideration of these factors may help prevent implant-related fractures in children.
Background:
To our knowledge, there are no comprehensive clinical studies of implant-related fractures in children. Our goal was to identify the incidence, skeletal location, and associated diagnoses of implant-related fractures.
Methods:
We reviewed our institutional database to identify cases of implant insertion (7584 cases) in patients less than 18 years old from January 1, 1995 through December 31, 2009. We calculated the overall incidence of these fractures and stratified the incidence by skeletal location and preoperative diagnoses. Fisher exact test was used to ascertain differences in fracture incidence. Risk ratios were calculated when appropriate. Significance was set at P<0.05.
Results:
There were 25 cases of implant-related fractures: 22 in the femur, 2 in the tibia, and 1 in the radius. The overall incidence of implant-related fracture was 0.33%; the incidence by skeletal location was: femur, 0.89%; tibia, 0.1%; and radius, 0.14%. Associated diagnoses were cerebral palsy (9 cases), hip dysplasia (3 cases), spina bifida (2 cases), and avascular necrosis (1 case); 10 cases were associated with "other diagnoses," which included various skeletal syndromes (5 cases) and traumatic fractures (5 cases). The incidences of implant-related fractures by diagnoses were: cerebral palsy, 1.1%; hip dysplasia, 1.1%; spina bifida, 1.3%; and avascular necrosis, 0.35%. The incidence of implant-related fracture in the "other diagnoses" group was 0.16%, and the incidence of fracture in otherwise healthy patients was 0.084%. The femur was 15.2 times more likely to fracture than other bones (P<0.001). Diagnoses of cerebral palsy, hip dysplasia, spina bifida, and avascular necrosis were 6.1 times more likely to be associated with implant-related fractures than the "other diagnoses" (P<0.001). The mean time to fracture in the study was 2.8 years. The overall implant removal rate at our institution was 24.3%, and it varied significantly by patient diagnosis (P<0.01).
Conclusions:
Skeletal location and preoperative diagnosis should be factors of consideration in a surgeon's decision about removing implants to prevent implant-related fractures.
Level Of Evidence:
Prognostic Level III.
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