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Does postoperative immobilization affect final alignment of pediatric femur fractures treated with flexible
Adam Michael Miller1, Rutledge Carter Clement1,2, Claudia Leonardi3
1Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center.
Insights
Flexible intramedullary nailing (FIN) for pediatric femur fractures shows no difference in healing alignment whether or not immobilization is used post-surgery. Both immobilization and no immobilization are viable options for pediatric femoral shaft fractures treated with FINs.
Area of Science:
- Pediatric Orthopedics
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Flexible intramedullary nail (FIN) fixation is a common treatment for pediatric femur fractures.
- Postoperative immobilization choices (casting, bracing, or none) vary and are surgeon-dependent.
Purpose of the Study:
- To determine if postoperative immobilization status affects radiographic alignment in pediatric femur fractures treated with FINs.
Main Methods:
- Retrospective review of 41 pediatric patients with femur fractures treated with FINs (April 2018 - July 2022).
- Patients were categorized into immobilized (IMM) and non-immobilized (NoIMM) groups.
- Radiographic alignment was assessed immediately post-surgery and at healing.
Main Results:
- No significant difference in radiographic alignment at the time of healing was observed between the IMM and NoIMM groups.
- Patient demographics, fracture characteristics, and clinical outcomes were compared.
Conclusions:
- Postoperative immobilization status does not significantly impact radiographic alignment in pediatric femur fractures treated with flexible intramedullary nailing.
- Both immobilization and non-immobilization are acceptable management strategies following FIN fixation for pediatric femoral shaft fractures.
Abstract:
Flexible intramedullary nail (FIN) fixation of pediatric femur fractures is a popular method of fixation in children. Typical immobilization options include spica casting, long leg cast, knee immobilizers, or no immobilization and the decision to use each is usually left to surgeon preference. Our primary aim is to evaluate whether different postoperative immobilization status influences outcomes, namely radiographic alignment at the time of healing. A retrospective chart review was conducted of all patients with femur fractures treated with FIN fixation at a pediatric hospital from April 2018 through July 2022. Postoperative immobilization protocols were recorded and separated into two groups, patients who were immobilized (IMM) and patients who were not immobilized (NoIMM). Radiographs were evaluated for fracture alignment immediately following surgery and at the time of healing. Patients demographic, fracture, and postoperative clinical characteristics were compared between the two groups (NoIMM vs. IMM). A total of 41 patients were treated for diaphyseal femur fractures with FINs at our institution during the study period. No significant difference was observed in alignment at healing. Our results suggest that either immobilization or no immobilization after flexible intramedullary nailing of pediatric femoral shaft fractures are viable options when postoperative immobilization status is left to the surgeon's discretion.
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