Bone Overgrowth after Femoral Shaft Fracture in Children Managed by Operative Versus Non-Operative Techniques in Sulaimani City
Keywords:
Bone overgrowth,Bone overgrowth, Bone shortening, Clinical assessment, Comparative study, Fracture management, X-rayAbstract
Background and objectives: Femoral overgrowth is not related to age, fracture level, or fractureanatomical location. This study measures the amount of bone overgrowth in operative and non-operative
ways to manage femoral shaft fractures in children.
Methods: In this prospective cohort study, 50 participants with femoral shaft fractures were recruited at
Shar/Shorsh teaching hospitals from June 2022 to June 2023. We collected patients' socio-demographics
and clinical data (fracture side, site, and the mode of the treatment they received). The participants were
treated with various methods. Later, we assessed the mean shortening at the time of bone union and
overgrowth after one year of follow-up by x-ray and clinical exam.
Results: Most shaft fractures were at the dominant side (74%), mid-femur (64%), and (52%) had
undergone hip Spica. No-operatively managed cases comprised (52%). There was a significant
difference in the femoral shortening before and after one year using the X-ray parameter (p=0.000).
Moreover, a statistically significant difference (p=0.038) was seen in femoral overgrowth after one year
of follow-up by x-ray assessment only. Additionally, non-significant differences were noted between all
treatment types (hip Spica, plate and screw, elastic nail, and closed reduction + external fix) in femoral
shortening at the time of union/femoral overgrowth using both x-ray and clinical assessment following a
year.
Conclusion: No significant difference was noticeable in the amount of bone overgrowth between
operative and non-operative managements that caused no laming or restriction of daily activities.
References
Almukhtar A, Alany A. Bone Overgrowth Following Diaphyseal Femoral Fracture in
Children Basrah j. Surg. 2015; 12:1-8.
Sink E, Faro F, Polousky J, Flynn K, Gralla J. Decreased complications of pediatric femur
fractures with a change in management. J Pediatr Orthop. 2010 Oct-Nov;30(7):633-7.
Duffy S, Gelfer Y, Trompeter A, Clarke A, Monsell F. The clinical features, management
options and complications of pediatric femoral fractures. Eur J of Orthop Surg Traumatol.
;883-92.
Campbell TM, Ghaedi BB, Ghogomu ET, Welch V. Shoe lifts for leg length discrepancy in
adults with common painful musculoskeletal conditions: a systematic review of the literature.
Arch. of Physical Med. and Rehab. 2018;981-93.
Shapiro F. Developmental patterns in lower-extremity length discrepancies. J. Bone Joint
Surg. Am.1982; 64:639-51.
Still S, Magnani M, Lampasi M, Antonioli D, Bettuzzi C, Donzelli O. Remodelling and
overgrowth after conservative treatment for femoral and tibial shaft fractures in children. La
Chirurg. degli Organi di Movimento. 2008; 13-19.
Madhuri V, Dutt V, Gahukamble AD, Tharyan P. Interventions for treating femoral shaft
fractures in children and adolescents, Evidence‐Based Child Health: A Cochrane Review J.
; 753-826.
Truesdell ED. Inequality of the lower extremities following fracture of the shaft of the femur
in children. Annals of Surg. 1921; 498-500.
Hedin H. External Fixation of Femoral Fractures in Children: Clinical, radiological and
functional outcome and cost analysis. Acta Universitatis Upsaliensis, 2003.
Kim TG, Park MS, Lee SH, Choi KJ, Im BE, Kim DY. Leg-length discrepancy and
associated risk factors after paediatric femur shaft fracture: a multicentre study. J. of Child.
Orthop. 2021; 215-222.
Lucak T, Raju S, Andrews A, Igbokwe L, Heffernan M.J. Dimensions of the pediatric
femur: anatomical limitations of flexible intrameduallary nailing. J Child Orthop. 2019; April;
; 13(2): 220-25.
Engström Z, Wolf O, and Hailer YD. Epidemiology of pediatric femur fractures in children:
the Swedish Fracture Register. BMC Musculoskeletal Disorders. 2020; 1-8.
Heideken Von J, Svensson T, Blomqvist P, Haglund-Åkerlind Y, Janarv P.M. Incidence and
trends in femur shaft fractures in Swedish children between 1987 and 2005. J. of Pediatr.
Orthop. 2011;512-19.
Loder RT, Feinberg JR. Epidemiology and mechanisms of femur fractures in children. J. of
Pediatr. Orthop. 2006; 561-67.
Marks R, Allegrante JP, MacKenzie CR, Lane J.M. Hip fractures among the elderly: causes,
consequences and control. Aging Res. Rev. 2003; 57-93.
Jain A, Aggarwal A, Gulati D, Singh M. Controversies in orthopaedic trauma-management
of fractures of the shaft of femur in children between 6 and 12 years of age. Kathmandu Univ.
Med. J. 2014; 77-84.
Boardman MJ, Herman MJ, Buck B, Pizzutillo PD. Hip fractures in children. JAAOS-J. of
the American Academy of Orthop. Surg. 2009; 162-173.
Becker T, Weigl D, Mercado E, Katz K, Bar-On E. Fractures and refractures after femoral
locking compression plate fixation in children and adolescents. J. of Pediatr. Orthop. e40-e46,
; e-40-46.
Dial BL, Lark R.K. Pediatric proximal femur fractures. J. of Orthop. 2018; 529-35.
Liau GZ, Lin HY, Wang Y, Nistala KR, Cheong CK, Hui JH. Pediatric femoral shaft
fracture: an age-based treatment algorithm. Indian J. of Orthop. 2021; 55-67.
Gandhi VP, Patel P. Fracture of the femoral shaft related with bone overgrowth in children
admitted at tertiary care institute of Gujarat. International J. of Orthop. 2019; 118-20.
Basener CJ, Mehlman CT, Dipasquale TG. Growth disturbance after distal femoral growth
plate fractures in children: a meta-analysis. J. of Orthop. Trauma. 2009; 663-67.
Wilkins KE, Beaty JH. Rockwood and Wilkins' Fractures in Children: Lippincott-Raven,
Chen X, Lu M, Xu W, Wang X, Xue M, Dai J. Treatment of pediatric femoral shaft
fractures with elastic stable intramedullary nails versus external fixation: a meta-analysis.
Orthop. & Trauma: Surg. & Res. 2020; 1305-11.
Omer AB, Khursheed SH. Treatment of femoral shaft fractures by closed reduction and
external fixation. Bas J. Surg. 2012; March;18; 56-63.
Yong SM, Saw A, Sengupta S, Bulgiba AM. Bone Overgrowth after Fracture of the
Femoral Shaft in Children. Malaysian Orthop. J. 2007; May; 11: 8-11
Downloads
Published
Issue
Section
License
Copyright (c) 2024 University of Thi-Qar Journal Of Medicine
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
