Abstract
Objective To compare the clinical efficacy of closed reduction with spica casting(SC)ver-sus flexible intramedullary nail(FIN)for femoral shaft fractures in preschool children.Methods A retrospec-tive chart review was performed to identify children two to five years of age who had been treated for femoral shaft fracture.According to treatments,they were assigned into two groups of SC and FIN(n=20 each).Demographic profiles,associated injuries,injury severity,time indicators,total hospitalization expense,radiographic outcomes and complications were compared between two groups.Results A total of 40 children with a mean age of 37.73(24-57)month fulfilled the inclusion criteria.There were 28 boys and 12 girls.In SC and FIN groups,the per-centage of associated injuries was 5％and 40％;Median Injury Severity Score(ISS)9.0(9.0,9.0)and 10.0(9.0,13.8)(P=0.005);union time(52.90±10.30)and(53.05±10.85)day(P=0.950);full weight-bearing time(107.35±14.66)and(102.50±22.70)day(P=0.430);operative duration(34.95±17.63)and(102.70±27.93)min(P＜0.001);median length of postoperative hospital stay 1.5(1.0,2.0)and 2.0(2.0,3.0)day(P=0.075);total hospitalization expense(12 750.9±3 790.4)and(35 196.9±4 893.2)yuan(P＜0.001);coronal angulation 6.5(4.3,8.8)°,5.0(2.0,13.0)°,3.0(2.0,5.0)°,3.0(2.0,4.0)°,2.0(2.0,3.8)°,2.0(1.0,2.0)° at fracture union,full weight bearing and last follow-up(P＜0.001);sagittal angulation 9.5(6.3,13.0)°,8.5(5.3,11.5)°,5.0(3.3,7.8)°,4.0(2.0,5.0)°,3.0(2.0,4.0)°,2.0(2.0,3.0)°(P＜0.001).At the last follow-up,limb length discrepancy was(5.30±3.26)in SC group and(7.78±5.01)mm in FIN group(P=0.073);excellent/decent rate of Flynn score 90％and 95％.And the difference was not statistically significant(P=0.800).The incidence of postoperative complications was 10％in both groups.All complications were classified as Clavien-Dindo grade-Ⅰ/Ⅱ.Conclusions No significant difference exists in short-term healing process between two treatment modes under current domestic medical mod-el.As compared with SC,FIN is more expensive and requires a second surgery for removing nails.Long-term effi-cacy of two treatment methods and family burden of care should be further examined in the future.关键词
股骨干骨折/骨折闭合复位/骨折固定术,髓内/石膏,外科/儿童,学龄前Key words
Femoral Shaft Fractures/Closed Fracture Reduction/Fracture Fixation,Intramedullary/Casts,Surgical/Child,Preschool
