Abstract
In the last twenty years, the incidence of paediatric long bone diaphyseal fractures has increased, owing to changes in the daily-life activities of children.
The fracture pattern is different considering the child’s age, the increasing participation in sports and the large number of children involved in car accidents or who are victims of abuse. Healing times will be different depending on age, because younger children take less time to heal. Another characteristic of developmental age is the capacity of spontaneous correction of malalignment. Deformities can be spontaneously corrected in the frontal and sagittal planes, while this is not possible for rotational deformities: this peculiarity of children decreases with age.
Therefore, in the choice of therapy the child’s age and the type of fracture should be considered. The type of treatment has changed over the years from a large use of casting treatment to surgical approaches by means of instruments made specifically for the developmental age. The aim of this article is to describe the general characteristics of paediatric diaphyseal fractures of the humerus, forearm, femur and tibia and the principles of non-surgical and surgical treatment in the different age groups.
Speaking about non-surgical treatment, the principles of cast application for each anatomical area are described along with the timing of the treatment and the limits of tolerated deformities. The surgical treatment consists of intramedullary osteosynthesis (using elastic nail or Kirschner wires), external fixation and in selected cases plate and screws fixation. The indications for each technique are discussed together with the basics of application and the complications.
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Bibliografia
Xian CJ, Foster BK (2006) Aspetti biologici delle fratture nei bambini. In: Beaty K (ed) Rockwood e Wilkins. Traumatologia Pediatrica. Verduci, Roma, pp 29–31
Cheng JC, Shen WY (1993) Limb fracture pattern in different pediatric age groups: a study of 3350 children. J Orthop Trauma 7:15–22
Shaw BA, Murphy KM, Shaw A et al. (1997) Humerus shaft fractures in young children: accident or abuse? J Pediatr Orthop 17:293–297
Ahn JI, Park JS (1994) Pathological fractures secondary to unicameral bone cysts. Int Orthop 18:20–22
Beaty JH (1992) Fractures of the proximal humerus and shaft in children. AAOS Instr Course 41:369–372
Klenerman L (1966) Fractures of the shaft of the humerus. J Bone Jt Surg Br 48:105–111
Rang M (1983) Children’s Fractures, 2nd edn. JB Linpincott, Philadelphia, pp 154–161
Webb L, Mooney J (2003) Fractures and dislocations about the shoulder. In: Green N, Swiontkowski M (eds) Skeletal Trauma in Children. Saunders, Philadelphia, pp 322–343
Caviglia HH, Garrido CP, Palazzi FF, Meana NV (2005) Pediatric fractures of the humerus. Clin Orthop Relat Res 432:49–56
Wade Shrader M (2007) Proximal humeral and humeral shaft fractures in children. Hand Clin 23:431–435
Bukvic N, Kvesic A, Brekalo Z et al. (2011) The validity of ESIN method of osteosynthesis compared to other active surgical method of treatment of diaphyseal fractures of long bones in children and adolescents. Coll Antropol 2:403–408
Kaelin A (2005) Elastic stable intramedullary nailing of diaphyseal fractures in children. In: Efort European Instructional Course Lectures, vol 7, pp 37–39
Garg S, Dobbs MB (2009) Surgical treatment of traumatic pediatric humeral diaphyseal fractures with titanium elastic nails. J Child Orthop 3:121–127
Senes FM, Catena N (2012) Intramedullary osteosynthesis for metaphyseal and diaphyseal humeral fractures in developmental age. J Pediatr Orthop, B 21:300–304
Asche G (1986) Use of external fixation in pediatric fractures. Zentralbl Chir 111:391–397
Senes FM, Campus R, Becchetti F, Catena N (2009) Upper limb nerve injuries in developmental age. Microsurgery 29:529–535
Melhman CT, Wall EJ (2006) Lesioni della diafisi del radio e dell’ulna. In: Beaty K (ed) Rockwood e Wilkins. Traumatologia Pediatrica. Verduci, Roma, pp 407–412
Noonan KJ, Price CT (1996) Forearm and distal radius fractures in children. J Am Acad Orthop Surg 6:146–156
Jones K, Weiner DS (1999) The management of forearm fractures in children: a plea for conservatism. J Pediatr Orthop 19:811–815
Boero S, Michelis MB, Calevo MG, Stella M (2007) Multiple forearm diapsyseal fracture: reduction and plaster cast control at the end of growth. Int Orthop 31:807–810
Sinikumpu JJ, Lautamo A, Pokka T, Serlo W (2012) The increasing incidence of paediatric diaphyseal both bone forearm fractures and their internal fixation during the last decade. Injury 43:362–366
Yung SH, Lam CY, Choi KY et al. (1998) Percutaneous intramedullary Kirschner wiring for displaced diaphyseal forearm fractures in children. J Bone Jt Surg Br 80:91–94
Dietz JF, Bae DS, Reiff E et al. (2010) Single bone intramedullary fixation of the ulna in pediatric both bone forearm fractures: analisys of short term clinical and radiographic results. J Pediatr Orthop 30(5):420–424
Patel A, Lily L, Anand A (2014) Systematic review: functional outcomes and complications of intramedullary nailing versus plate fixation for both bone diaphyseal forearm fractures in children. Injury 45(8):1135–1143
Weiss J, Mencio GA (2012) Forearm shaft fracture: does fixation improve outcomes? J Pediat Orthop 32(1):22–24
Colaris JW, Allema JH, Reijman M et al. (2014) Which factors affect limitation of pronation/supination after forearm fractures in children? A prospective multicentre study. Injury 45(4):696–700
Kasser JR, Beaty JH (2006) Fratture della diafisi femorale. In: Beaty K (ed) Rockwood e Wilkins. Traumatologia Pediatrica. Verduci, Roma, pp 894–896
Staheli LT (1967) Femoral and tibial growth following femoral shaft fracture in childood. Clin Orthop Relat Res 55:159–163
Kamenaga M, Saisu T, Segawa Y et al. (2012) Remodeling of angulation in diaphyseal femorale fracture in children. J Orthop Sci 17:763–769
Catena N, Senes FM, Riganti S, Boero S (2014) Diaphyseal femoral fractures below the age of six years: results of plaster application and long term follow up. Indian J Orthop 48(1):30–34
Reynolds RA, Legakis JE, Thomas R et al. (2012) Intramedullary nails for pediatric diaphyseal femur fractures in older, heavier children: early results. J Child Orthop 6:181–188
Aslani H, Tabrizi A, Sadighi A, Mirbolook AR (2013) Treatment of pediatric open femoral fractures with external fixator versus flexible intramedullary nails. Arch Bone Jt Surg 1(2):64–67
Ramseier LE, Janicki JA, Weir S, Narayam UG (2010) Femoral fractures in adolescents: a comparison of four methods of fixation. J Bone Jt Surg Am 92:1122–1129
Heinrich SD, Mooney JF III (2006) Fratture della diafisi tibio peroneale. In: Beaty K (ed) Rockwood e Wilkins. Traumatologia Pediatrica. Verduci, Roma, pp 1039–1044
Stilli S, Magnani M, Lampasi M et al. (2008) Remodelling and overgrowth after conservative treatment for femoral and tibial shaft fractures in children. Chir Organi Mov 91:13–19
Jung ST, Park H, Lee JH, Kim JR (2014) Residual angulation of distal tibial diaphyseal fractures in children younger than ten years. J Orthop Surg Res 9:84
Chotel F, Berard J, Parot R (2002) Fractures de jambe. In: Clavert JM, Karger C, Lascombes P et al. (eds) Fractures de l’enfant. Sauramps Medical, Montpellier, pp 247–259
Griffet J, Leroux J, Boudjouraf N et al. (2011) Elastic stable intramedullary nailing of tibial shaft fractures in children. J Child Orthop 5:297–304
Gordon JE, Gregush RV, Schoenecker PL et al. (2007) Complications after titanium elastic nailing of pediatric tibial fractures. J Pediatr Orthop 27(4):442–446
Monsell FP, Howells NR, Lawniczak D et al. (2012) High energy open tibial fractures in children. J Bone Jt Surg Br 94B:989–993
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Gli autori Nunzio Catena, Valentina Camurri, Filippo M. Sénès e Silvio Boero dichiarano di non aver alcun conflitto di interesse.
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Catena, N., Camurri, V., Sénès, F.M. et al. Le fratture diafisarie in età pediatrica. LO SCALPELLO 29, 36–43 (2015). https://doi.org/10.1007/s11639-015-0101-4
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DOI: https://doi.org/10.1007/s11639-015-0101-4