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Can J Surg. 2000 Jun;43(3):180-9.

The treatment of femoral shaft fractures in children: a systematic overview and critical appraisal of the literature.

Author information

  • 1Department of Surgery and Public Health Sciences, University of Toronto, Ont. jgwright@sickkids.on.ca

Abstract

OBJECTIVE:

Through a critical systematic overview of the literature on the treatment of pediatric femoral shaft fractures to determine if any method of treatment can be recommended over others.

DATA SOURCES:

A MEDLINE search was performed for all cohort and randomized clinical trials for the years 1966 to 1996.

STUDY SELECTION:

Of 1217 identified articles, 15 cohort studies (where 2 or more treatments were compared in the same study) reported the treatment of children with femoral fractures.

DATA EXTRACTION:

Information was abstracted and articles rated for quality blind to author, institution and journal.

DATA SYNTHESIS:

Children having early application of a hip spica cast had an average hospital stay of 11 days (range from 5 to 29 days), average charges of $5784 (range from $590 to $11,800), average rates of limb-length discrepancy (greater than 2 cm) of 3% (range from 0 to 25%), angulatory malunion rates (greater than 10 degrees) of 8% (range from 0 to 19%), and rotational malunion rates (greater than 10 degrees) of 13% (range from 0 to 5%). The costs and malunion rates of early application of a hip spica cast were lower than for traction. Internal fixation (including intramedullary nails) had low angulatory malunion rates compared with early application of a hip spica cast but higher over-lengthening rates (greater than 2 cm) of 25% (range from 5% to 100%) and mean rotational malunion rates (greater than 10 degrees) of 25% (range from 11% to 32%).

CONCLUSION:

Early application of a hip spica cast had lower costs and malunion rates than traction.

PMID:
10851411
[PubMed - indexed for MEDLINE]
PMCID:
PMC3695159
Free PMC Article
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