Application of closed reduction with femoral fracture reductor and elastic intramedullary nail internal fixation in the treatment of subtrochanteric fracture in children
Liu Yuchang, Wang Xuan, Su Yunshan, Han Jiuhui, Li Yazhou, Luo Junzhong
Department of Pediatric Orthopaedics, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
Abstract：Objective To explore the clinical effect of closed reduction with femoral fracture reductor and elastic intramedullary nail internal fixation in the treatment of subtrochanteric femoral fracture in children. Methods The clinical data of seven children with subtrochanteric fracture who were admitted to the Third Hospital of Hebei Medical University from January 2017 to May 2019 were analyzed retrospectively. Among the children, five were males and two were females, and all aged between 4 and 9 years (mean of 6.2 years). Among the fractures, four were located on the left and three were on the right femur. In particular, one was in Seinheimer ⅡA, three were in ⅡB, another one was in ⅡC, and two were in ⅢA. After closed reduction with femoral fracture reductor was performed, all seven cases were fixed with elastic intramedullary nail. The success rate of closed reduction, the operation time, the intraoperative blood loss, the postoperative hospital stay, and the fracture healing time were observed. The early curative effect was evaluated in accordance with Beaty's standard imaging evaluation 4 weeks after the operation. The function of the affected limb was evaluated in accordance with the Flynn score during the last follow up. Results All cases achieved satisfactory reduction with the use of femoral fracture reductor, and the elastic intramedullary nail was successfully placed, and the fracture fixation was stable. The operation time was 28-55 min, with an average of 36 min. The intraoperative blood loss was 5-15 mL, with an average of 8 ml. The postoperative hospital stay was 3-5 d, with an average of 4 d. All patients were followed up for 6-28 months, with an average of 22 months. All fractures healed in 6-10 weeks, with an average of 7.2 weeks. The early curative effect was evaluated 4 weeks after the operation in accordance with Beaty's standard imaging evaluation, and the results showed that all children were satisfied. During the last follow up, the function of the affected limb was evaluated on the basis of the Flynn score, and the results were excellent in six cases and good in one case. Conclusions Using femoral fracture reductor for subtrochanteric fracture in children has the advantages of simple operation, high success rate of closed reduction, high-quality fracture reduction, effective maintenance of fracture alignment, and reduced radiation exposure time.
刘玉昌, 王宣, 苏云山, 韩久卉, 李亚洲, 罗军忠. 股骨骨折复位器闭合复位弹性髓内钉内固定术在儿童股骨转子下骨折治疗中的应用[J]. 中华解剖与临床杂志, 2020, 25(6): 673-677.
Liu Yuchang, Wang Xuan, Su Yunshan, Han Jiuhui, Li Yazhou, Luo Junzhong. Application of closed reduction with femoral fracture reductor and elastic intramedullary nail internal fixation in the treatment of subtrochanteric fracture in children. Chinese Journal of Anatomy and Clinics, 2020, 25(6): 673-677.
Jarvis J, Davidson D, Letts M.Management of subtrochanteric fractures in skeletally immature adolescents[J]. J Trauma, 2006, 60(3): 613-619. DOI:10.1097/01.ta.0000197606.63124.9e.
[2]
Hajdu S, Oberleitner G, Schwendenwein E, et al.Fractures of the head and neck of the femur in children: an outcome study[J]. Int Orthop, 2011, 35(6): 883-888. DOI:10.1007/s00264-010-1039-z.
[3]
Parikh SN, Nathan ST, Priola MJ, et al.Elastic nailing for pediatric subtrochanteric and supracondylar femur fractures[J]. Clin Orthop Relat Res, 2014, 472(9): 2735-2744. DOI:10.1007/s11999-013-3240-z.
[4]
罗雷茗, 鲁晓波, 伍维, 等. 闭合与切开复位弹性髓内钉内固定治疗儿童股骨粗隆下骨折疗效比较[J]. 中国修复重建外科杂志, 2015, 29(11): 1337-1341. DOI:10.7507/1002-1892.20150289.Luo LM, Lu XB, Wu W, et al.Effectiveness comparison between open and closed reduction using elastic stable intramedullary nailing for pediatricsubtrochanteric fractures[J]. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(11): 1337-1341. DOI:10.7507/1002-1892.20150289.
[5]
Kelly BA, Naqvi M, Rademacher ES, et al.Fracture table application for pediatric femur fractures: incidence and risk factors associated with adverse outcomes[J]. J Pediatr Orthop, 2017, 37(6): e353-e356. DOI:10.1097/BPO.0000000000001036.
[6]
刘玉昌, 罗军忠, 李亚洲, 等. 儿童股骨干骨折外固定复位器的设计及应用[J]. 中华创伤骨科杂志, 2019, 21(10): 869-873. DOI: 0.3760/cma.j.issn.1671-7600.2019.10.009.Liu YC, Luo JZ, Li YZ, et al.Application of a self-disigned external fixation restorer for femoral shaft fractures in children[J]. Chin J Orthop Trauma, 2019, 21(10):869-873. DOI:10.3760/cma.j.issn.1671-7600.2019.10.009.
[7]
Beaty JH.Femoral-Shaft fractures in children and adolescents[J]. J Am Acad Orthop Surg, 1995, 3(4): 207-217. DOI:10.5435/00124635-199507000-00003.
[8]
Flynn JM, Hresko T, Reynolds RA, et al.Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications[J]. J Pediatr Orthop, 2001, 21(1): 4-8. DOI:10.1097/00004694-200101000-00003.
[9]
Pombo MW, Shilt JS.The definition and treatment of pediatric subtrochanteric femur fractures with titanium elastic nails[J]. J Pediatr Orthop, 2006, 26(3): 364-370. DOI:10.1097/01.bpo.0000203005.50906.41.
Li Y, Heyworth BE, Glotzbecker M, et al.Comparison of titanium elastic nail and plate fixation of pediatric subtrochanteric femur fractures[J]. J Pediatr Orthop, 2013, 33(3): 232-238. DOI:10.1097/BPO.0b013e318288b496.
[12]
Roaten JD, Kelly DM, Yellin JL, et al.Pediatric femoral shaft fractures: a multicenter review of the aaos clinical practice guidelines before and after 2009[J]. J Pediatr Orthop, 2019, 39(8): 394-399. DOI:10.1097/BPO.0000000000000982.
[13]
Momaya A, Baker D, Gilbert S, et al.Risk factors for complications and readmission after operative fixation of pediatric femur fractures[J]. J Child Orthop, 2015, 9(4): 307-311. DOI:10.1007/s11832-015-0672-x.
[14]
潘骏, 武垚森, 易先宏, 等. 弹性髓内钉治疗大龄儿童股骨粗隆下骨折的临床疗效分析[J]. 中华小儿外科杂志, 2010, 31(1): 34-37. DOI:10.3760/cma.j.issn.0253-3006.2010.01.010.Pan J, Wu YS, Yi XH, et al.The efficacy of elastic intramedullary nailing for femoraI subtrochanteric fractures in older children[J]. Chin J Pediatr Surg, 2010, 31(1): 34-37. DOI:10.3760/cma.j.issn.0253-3006.2010.01.010.
[15]
吴敏, 官建中, 陈笑天, 等. 经皮闭合复位弹性髓内钉固定治疗儿童股骨转子下骨折[J]. 中国矫形外科杂志, 2016, 24(10): 874-878. DOI:10.3977/j. issn.1005-8478.2016.10.03.Wu M, Guan JZ, Chen XT, et al.Clinical efficacy of percutaneous closed reduction and elastic stable intramedullary nail fixation in children with subtrochanteric femoral fracture[J]. Orthopedic Journal of China, 2016, 24(10): 874-878. DOI:10.3977/j.issn.1005-8478.2016.10.03.
2020, Vol. 25 
