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Predictors of Open Reduction in Pediatric Femur Fractures Treated With Flexible Nails.

Abstract

BACKGROUND

Closed reduction (CR) is sufficient to reduce the majority of femur fractures treated with flexible intramedullary nailing (FIN). No previous study has examined factors associated with failed CR of pediatric femoral shaft fractures treated with FIN. We sought to determine preoperative factors associated with failed CR. We hypothesized that fracture, patient, and surgeon characteristics would impact the need for open reduction (OR).

METHODS

A retrospective review of children treated for femur fracture between 2012 and 2017 at a tertiary pediatric hospital was performed. Comparisons were made between 2 groups: FIN with CR group and FIN that required OR group. Demographic and baseline characteristics were compared between treatment groups using either χ tests or Fisher exact tests for categorical variables and general linear models for continuous variables. Odds ratios with 95% confidence intervals were calculated using univariate logistic regression tests.

RESULTS

Of 449 consecutive pediatric femur fractures treated at our center, 85 children were treated with FIN and constituted the study cohort. CR failed in 14 patients (16.5%) necessitating OR of the fracture site. Significant differences between study groups were found in fracture location (P=0.018), the mechanism (P=0.003), and displacement on the anteroposterior radiograph (P=0.027). Surgical time was found to be longer in the OR group (P=0.010). We identified 3 preoperative predictors of OR for FIN including fractures caused by high energy mechanisms (odds ratio=7.5), distal third fractures (odds ratio=15.3), and fracture displacement on the anteroposterior view (odds ratio=1.06). Surgeon years in practice, patient weight, age, and time from injury to surgery were not associated with OR.

CONCLUSIONS

This study presents 3 preoperative risk factors that predict the need for OR of femur fractures treated with FIN. Surgical time was longer in cases that required OR. Our findings suggest that surgeons should avoid lengthy attempts at CR and consider a lower threshold for OR of at-risk fractures or use another technique other than flexible nails.

LEVEL OF EVIDENCE

Level III-prognostic.

Authors+Show Affiliations

Children's Hospital New Orleans.Children's Hospital New Orleans.Children's Hospital New Orleans.Children's Hospital New Orleans.School of Public Health, LSU Health Sciences Center, New Orleans, LA.Children's Hospital New Orleans.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31972726

Citation

Heffernan, Michael J., et al. "Predictors of Open Reduction in Pediatric Femur Fractures Treated With Flexible Nails." Journal of Pediatric Orthopedics, 2020.
Heffernan MJ, Shelton W, Song B, et al. Predictors of Open Reduction in Pediatric Femur Fractures Treated With Flexible Nails. J Pediatr Orthop. 2020.
Heffernan, M. J., Shelton, W., Song, B., Lucak, T. J., Leonardi, C., & Kadhim, M. (2020). Predictors of Open Reduction in Pediatric Femur Fractures Treated With Flexible Nails. Journal of Pediatric Orthopedics, doi:10.1097/BPO.0000000000001511.
Heffernan MJ, et al. Predictors of Open Reduction in Pediatric Femur Fractures Treated With Flexible Nails. J Pediatr Orthop. 2020 Jan 17; PubMed PMID: 31972726.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of Open Reduction in Pediatric Femur Fractures Treated With Flexible Nails. AU - Heffernan,Michael J, AU - Shelton,William, AU - Song,Bryant, AU - Lucak,Thomas J, AU - Leonardi,Claudia, AU - Kadhim,Muayad, Y1 - 2020/01/17/ PY - 2020/1/24/entrez PY - 2020/1/24/pubmed PY - 2020/1/24/medline JF - Journal of pediatric orthopedics JO - J Pediatr Orthop N2 - BACKGROUND: Closed reduction (CR) is sufficient to reduce the majority of femur fractures treated with flexible intramedullary nailing (FIN). No previous study has examined factors associated with failed CR of pediatric femoral shaft fractures treated with FIN. We sought to determine preoperative factors associated with failed CR. We hypothesized that fracture, patient, and surgeon characteristics would impact the need for open reduction (OR). METHODS: A retrospective review of children treated for femur fracture between 2012 and 2017 at a tertiary pediatric hospital was performed. Comparisons were made between 2 groups: FIN with CR group and FIN that required OR group. Demographic and baseline characteristics were compared between treatment groups using either χ tests or Fisher exact tests for categorical variables and general linear models for continuous variables. Odds ratios with 95% confidence intervals were calculated using univariate logistic regression tests. RESULTS: Of 449 consecutive pediatric femur fractures treated at our center, 85 children were treated with FIN and constituted the study cohort. CR failed in 14 patients (16.5%) necessitating OR of the fracture site. Significant differences between study groups were found in fracture location (P=0.018), the mechanism (P=0.003), and displacement on the anteroposterior radiograph (P=0.027). Surgical time was found to be longer in the OR group (P=0.010). We identified 3 preoperative predictors of OR for FIN including fractures caused by high energy mechanisms (odds ratio=7.5), distal third fractures (odds ratio=15.3), and fracture displacement on the anteroposterior view (odds ratio=1.06). Surgeon years in practice, patient weight, age, and time from injury to surgery were not associated with OR. CONCLUSIONS: This study presents 3 preoperative risk factors that predict the need for OR of femur fractures treated with FIN. Surgical time was longer in cases that required OR. Our findings suggest that surgeons should avoid lengthy attempts at CR and consider a lower threshold for OR of at-risk fractures or use another technique other than flexible nails. LEVEL OF EVIDENCE: Level III-prognostic. SN - 1539-2570 UR - https://www.unboundmedicine.com/medline/citation/31972726/Predictors_of_Open_Reduction_in_Pediatric_Femur_Fractures_Treated_With_Flexible_Nails L2 - http://dx.doi.org/10.1097/BPO.0000000000001511 DB - PRIME DP - Unbound Medicine ER -