Risk factors for refracture of the femoral shaft in children after removal of external fixation

作者全名："Guo, Meizhen; Su, Yuxi"

作者地址："[Guo, Meizhen; Su, Yuxi] Chongqing Med Univ, China Int Sci & Technol Cooperat Base Child Dev &, Natl Clin Res Ctr Child Hlth & Disorders,Chongqin, Minist Educ,Key Lab Child Dev & Disorders,Dept Or, 136 Zhongshan 2rd, Chongqing 400014, Peoples R China"

通信作者："Su, YX (corresponding author), Chongqing Med Univ, China Int Sci & Technol Cooperat Base Child Dev &, Natl Clin Res Ctr Child Hlth & Disorders,Chongqin, Minist Educ,Key Lab Child Dev & Disorders,Dept Or, 136 Zhongshan 2rd, Chongqing 400014, Peoples R China."

来源：JOURNAL OF ORTHOPAEDICS AND TRAUMATOLOGY

ESI学科分类：　

WOS号：WOS:000621446400001

JCR分区：Q1

影响因子：2.8

年份：2021

卷号：22

期号：1

开始页：　

结束页：　

文献类型：Article

关键词：Femoral refracture; External fixation; Children

摘要："Background External fixation is the primary treatment option in children for femoral shaft fractures, such as open femoral or multiple fractures. One complication is refracture, which is the biggest limitation of fixation devices. This study aims to investigate the risk factors associated with refracture after the removal of external fixation devices and decrease the frequency of refracture. Materials and methods Retrospectively reviewed clinical data of 165 patients treated at our hospital for fresh femoral shaft fractures with external fixation between May 2009 and February 2018 were included in this study. Patients with pathological fractures, fractures of the femoral neck, fractures that were fixed using plates or elastic stable intramedullary nailing, and old fractures, as well as those who underwent postoperative femoral surgery were excluded. Potential risk factors included: patient age, gender, and weight, fracture sides, open or closed fracture, fracture sites, reduction methods, operation time, perioperative bleeding, number and diameter of the screws, and immobilization time. These factors were identified by univariate and logistic regression analyses. Results Femoral shaft refracture developed in 24 patients. Univariate analysis revealed that refracture was not statistically significantly associated with any of the above factors, except AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF) classification type 32-D/4.2 and L2/L3 ratio (L2, length of femur fixed by the two screws farthest from the fracture line; L3, the total length from the greater trochanter to the distal end of femur; P < 0.001 and P = 0.0141, respectively). Multivariate analysis showed that PCCF classification type 32-D/4.2 and L2/L3 ratio were also independent risk factors for femoral refracture. Conclusions Femoral shaft refracture is relatively common in children treated with external fixation. Because of the limited number of cases in this study, we cautiously concluded that the PCCF classification type 32-D/4.2 and L2/L3 ratio were independent risk factors for femoral shaft refracture in these patients."

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