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Femurschaftfrakturen im Kindesalter

Femoral shaft fractures in children

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Zusammenfassung

Femurschaftfrakturen machen ca.1,5% der Frakturen im Kindesalter aus. Während bis zum 4. Lebensjahr die konservative Behandlung im Beckenbeingips oder die kurzzeitige Overhead-Extension die Behandlung der Wahl ist, sollten die Oberschenkelschaftfrakturen bei Kindern jenseits des 4. Lebensjahres operiert werden. Die Technik ist in nahezu 90% der Fälle die retrograde elastisch stabile intramedulläre Nagelung (ESIN), die bei instabilen Situationen mit den „end caps“ optimiert werden kann. Alternativen wie der Fixateur externe oder die winkelstabilen Platten werden heute nur bei speziellen Frakturen angewendet und das bei Frakturen mit gravierenden Weichteilschäden und Gefäßverletzungen oder bei komplexen Frakturen. Unter Beachtung der Therapierichtlinien können sehr gute Ergebnisse erzielt werden.

Abstract

Femoral shaft fractures in children represent 1.5% of all fractures in childhood. Up to the age of 4 years, conservative treatment in a hip spica or short-term overhead traction is the therapy of choice. Femoral shaft fractures between the age of 5 and 16 years should be treated surgically. In over 90% of these cases elastic stable intramedullary nailing (ESIN) is the premier treatment option. Additional end caps can be used for unstable fractures and in length discrepancy. The external fixator and the locking plate are reserved for fractures with severe soft tissue injuries, vascular problems and some specific situations mentioned later on. By adhering to these standards good results can be achieved with a low complication rate.

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Literatur

  1. Baety JH, Austin SM, Warner WC et al (1994) Interlocking intramedullary nailing of the femoral shaft fractures in adolescents. Preliminary results and complications. J Pediat Orthop 14:178–183

    Article  Google Scholar 

  2. Brouwer KJ (1981) Torsional deformities after fractures in femoral shaft in childhood. Act Orthop Scand 195(Suppl):1–167

    CAS  Google Scholar 

  3. Clement DA, Colton CL (1986) Overgrowth of the femur after fracture in childhood. An increased effect in boys. J Bone Joint Surg Br 68:534–536

    PubMed  CAS  Google Scholar 

  4. Dietz HG, Schmittenbecher PP, Illing P (1997) Intramedulläre Osteosynthese im Wachstumsalter. Urban & Schwarzenberg, München

  5. Dietz HG, Joppich I, Marzi I et al (2001) Treatment of femoral fractures in childhood. Consensus Report of the 19th Meeting of the Child Traumatology Section of the DGU, Munich, 23–24 2000. Unfallchirurg 104:788–790

    Article  PubMed  CAS  Google Scholar 

  6. Dietz HG, Schmittenbecher PP, Slongo T, Wilkins KE (2006) Elastic stable intramedullary nailing (ESIN) in children. Thieme, Stuttgart

  7. Ferguson J, Nicol RO (2000) Early spica treatment of pediatric femoral shaft fractures. J Pediatr Orthop 20:189–192

    Article  PubMed  CAS  Google Scholar 

  8. Firica A, Popescu R, Scarlet M et al (1981) L’osteosynthese stable elastique, nouveau concept biomechanique. Etude experimentale. Rev Chir Orthop 67:82–91

    Google Scholar 

  9. Fyodorov I, Sturm PF, Robertson WW Jr (1999) Compression-plate fixation of femoral shaft fractures in children aged 8 to 12 years. J Pediatr Orthop 19:578–581

    Article  PubMed  CAS  Google Scholar 

  10. Golser K, Resch H, Spernre G, Thoni H (1991) Das Längenwachstumsverhalten nach Oberschenkelschaftfraktur im Kindesalter. Unfallchirurg 17:93–99

    Article  CAS  Google Scholar 

  11. Gonzalez-Herranz P, Burgos-Flores J, Rapariz JM, Lopez-Mondejar JA (1995) Intramedullary nailing of the femur in children effects on its proximal end. J Bone Joint Surg Am 77:262–266

    CAS  Google Scholar 

  12. Hedequist D, Bishop J, Hresko T (2008) Locking plate fixation for pediatric femur fractures. J Pediatr Orthop 28(1):6–9

    Article  PubMed  Google Scholar 

  13. Hedin H (2004) Surgical treatment of femoral fractures in children. Comparison between external fixation and elastic intramedullary nails: a review. Acta Orthop Scand 75:231–240

    Article  PubMed  Google Scholar 

  14. Heyworth BE, Galano GJ, Vitale MA, Vitale MG (2004) Management of closed femoral shaft fractures in children, ages 6 to 10: national practice patterns and emerging trends. J Pediatr Orthop 24:455–459

    Article  PubMed  Google Scholar 

  15. Holschneider AM, Vogl D, Dietz HG (1985) Differences in leg length following femoral shaft fractures in childhood. Z Kinderchir 40:341–350

    PubMed  CAS  Google Scholar 

  16. Jubel A, Andermahr J, Prokop A et al (2004) Pitfalls and complications of elastic stable intramedullary nailing (ESIN) of femur fractures in children. Unfallchirurg 107:744–749

    Article  PubMed  CAS  Google Scholar 

  17. Krettek C, Haas N, Tscherne H (1989) Versorgung der Femurschaftfraktur im Wachstumsalter mit dem Fixateur externe. Aktuelle Traumatol 19:255–261

    PubMed  CAS  Google Scholar 

  18. Kuner EH, Schlickewei W, Grossmann U (1989) Plate osteosynthesis in femoral shaft fractures. Z Unfallchir Versicherungsmed Berufskr 82:243–251

    PubMed  CAS  Google Scholar 

  19. Kuner EH (1991) Die Plattenosteosynthese zur Behandlung von Femurschaftfrakturen bei Kindern. Operat Orthop Traumatol 3:227–237

    Article  Google Scholar 

  20. Laerv LR, Krauzs R, Lindart WE (2007) Frakturen und Luxationen im Wachstumsalter, 5. Aufl. Thieme, Stuttgart

  21. Ligier JN, Metaizeau JP, Prevot J, Lascombes P (1988) Elastic stable intramedullary nailing of femoral shaft fractures in children. J Bone Joint Surg Br 70:74–77

    PubMed  CAS  Google Scholar 

  22. Maurer G, Parsch K (2000) Surgical treatment of pediatric femoral shaft fractures techniques in orthopaedics. Lippincot Williams & Wilkins, Philadelphia, pp 67–78

  23. Metaizeau JP (2004) Stable elastic intrmedullary nailing for fractures of the femur in children. J Bone Joint Surg Br 86:954–957

    Article  PubMed  CAS  Google Scholar 

  24. Ramseier LE, Janicki JA, Weiur S, Narayanan UG (2010) Femoral fractures in adolescents: a comparision of four methods of fixation. J Bone Joint Surg Am 92(5):1122–1129

    Article  PubMed  Google Scholar 

  25. Schmittenbecher PP, Dietz HG (1995) Elastic stable intramedullary nailing of femur fractures in children („Nancy-Nagelung“) Oper Orthop Traumatol 4:201–210

    Google Scholar 

  26. Schmittenbecher PP, Dietz HG, Linhart WE, Slongo T (2000) Complications and problems in intramedullary nailing of children’s fractures. Eur J Trauma 6:287–293

    Article  Google Scholar 

  27. Sink EL, Faro F, Polousky J et al (2010) Decreased complications of pediatric femur fractures with a change in management. J Pediatr Orthop 30(7):633–637

    Article  PubMed  Google Scholar 

  28. Slongo TF, Auzdige L (2007) AO Pediatric Classification Group Fracture and dislocation classification compendium for children: The AO pediatric comprehensive classification of long bone fractures (PCCF). J Orthop Trauma 21(Suppl 10):135–160

    Article  Google Scholar 

  29. Till H, Huttl B, Knorr P, Dietz HG (2000) Elastic stable intramedullary nailing (ESIN) provides good long-term results in pediatric long-bone fractures. Eur J Pediatr Surg 10:319–322

    Article  PubMed  CAS  Google Scholar 

  30. Yandow SM, Archibeck MJ, Stevens PM, Shultz R (1999) Femoral-shaft fractures in children: a comparison of immediate casting and traction. J Pediatr Orthop 19:55–59

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Kinderchirurgische Klinik im Dr. von Haunerschen Kinderspital, Klinikum der Universität, LMU München, Lindwurmstraße 4, 80337, München, Deutschland

    H.-G. Dietz

  2. Abteilung Unfall- und Wiederherstellungschirurgie, Kindertraumatologie, St. Josefskrankenhaus mit Kinderabteilung St. Hedwig, Freiburg, Deutschland

    W. Schlickewei

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  1. H.-G. Dietz
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  2. W. Schlickewei
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Correspondence to H.-G. Dietz.

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Dietz, HG., Schlickewei, W. Femurschaftfrakturen im Kindesalter. Unfallchirurg 114, 382–387 (2011). https://doi.org/10.1007/s00113-011-1970-5

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