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Objective:To identify the risk factors for premature proximal femur physeal closure (PPC) in children treated surgically for femoral neck fractures.Methods:Data of 106 children with an open triradiate cartilage who were treated surgically for a femoral neck fracture were retrospectively analyzed. Age, gender, laterality, mechanism of injury, the type of fracture, initial displacement, time to reduction, fixation method, whether the implant crossed the physeal plate, reduction method, reduction quality and development of femoral head avascular necrosis (AVN) were collected. PPC of the proximal femur was assessed through postoperative 6-12 months radiographs.Results:A total of 106 patients with an open triradiate cartilage were followed up, with an average duration of 20.4±13.3 months (range, 6-86 months). The overall rate of PPC following paediatric femoral neck fractures treated surgically was 36.8% (39/106). Among the 39 patients with PPC, 25 were males and 14 were females; the average age at the time of injury was 9.7±3.6 years (range, 3-15 years); 23 patients were involved in left hips and 16 were in right; the mechanisms of injury included motor vehicle accident in 5 fractures, falling injury in 21, sports-related injury in 12 and other causes in 1 fracture; two hips were Delbet type I, and 26 hips and 11 hips were Delbet type II and III, separately; type II and III of initial displacement were involved in 26 and 13 patients, separately; the mean duration from injury to surgery was 3.3±2.8 d (range, 1-14 d); 2 hips were treated with Kirschner wires, 35 hips with screw fixation, and the remaining 2 hips underwent screw and plate fixation; 2 hips had the hardware crossing the proximal femoral growth plate, and the remaining 37 hips didn’t; 15 hips were treated by closed reduction and internal fixation, and the other 24 hips underwent open reduction and internal fixation; anatomical reduction was achieved in 14 patients, acceptable reduction in 24 hips and unacceptable reduction in 1 hip; 24 hips developed AVN at the latest follow-up and the remaining 15 hips didn’t. Statistical analysis indicated that age ( t=3.875, P< 0.001), the severity of initial displacement ( Z=-2.118, P=0.034) and the rate of AVN ( χ2=42.280, P< 0.001) in patients with PPC were significantly higher than those in patients without; Logistic regression analysis confirmed age ( OR=1.288, P=0.011) and AVN ( OR=40.336, P< 0.001) as risk factors for PPC. ROC curve analysis indicated 10 years was the cut off age to significantly increase the rate of PPC. The rate of PPC in patients aged over 10 years (63.6%, 21/33) was significantly higher than that (24.7%, 18/73) in those aged less than 10 years ( χ2=14.848, P< 0.001). Conclusion:Age over 10 years and AVN are risk factors for PPC in children with femoral neck fractures treated surgically.
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Objective:To evaluate the clinical efficacy of intramedullary nailing for femoral shaft fracture in adolescents.Methods:From May 2017 to October 2019, 30 adolescent patients with femoral shaft fracture were treated at Department of Pediatric Orthopaedics, Foshan Hospital of Traditional Chinese Medicine. They were 20 males and 10 females, aged from 12 to 17 years (average, 14 years), with 13 left and 17 right sides affected. They were all fixated with intramedullary nailing; open reduction and internal fixation was performed in 12 cases and closed reduction and internal fixation in 18 cases. Recorded were operation time, intraoperative blood loss, and time for postoperative antibiotic use; compared were lower limb length, neck-shaft angle, femoral neck diameter (FND), articular trochanteric distance (ATD) and Harris scores between the healthy and affected sides at the final follow-up.Results:For the 18 patients undergoing closed reduction and 12 patients undergoing open reduction, respectively, the intraoperative blood loss averaged 153.2 mL and 238.0 mL, the operation time 70.5 min and 91.5 min, and the time for antibiotic use 1.5 d and 3.0 d. The 30 patients were followed up for 12 to 41 months (average, 20.3 months). Follow-up revealed no such complications as fracture nonunion, delayed union, malunion, heterotopic ossification of the hip, refracture of the femoral shaft, or developmental deformity of the proximal femur. The lower limb length, neck-shaft angle, FND, ATD and Harris scores at the final follow-up were, respectively, 133.4°±2.3°, (29.3±4.2) mm, (27.1±6.3) mm and 96.4±3.6 for the affected side, insignificantly different from those for the healthy side [132.4°±3.5°, (30.2±3.6) mm, (26.4±6.8) mm and 95.6±4.7] ( P>0.05). Conclusion:Intramedullary nailing is effective for femoral shaft fracture in adolescents, leading to positive efficacy and limited complications and impact on the development of proximal femur.
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Objective@#To compare the clinical efficacy between arthroscopic riveting with line and lateral retinacular release plus medial patellofemoral ligament reconstruction in the treatment of habitual patellar dislocation.@*Methods@#A retrospective study was conducted of the 40 children with habitual patellar dislocation who had been treated at Department of Pediatric Orthopaedics, Foshan Hospital of Traditional Chinese Medicine from January 2016 to December 2016. They were divided evenly into an observation group and a control group according to the treatment methods (n=20). In the observation group which was treated by lateral retinacular release plus medial patellofemoral ligament reconstruction, there were 14 boys and 6 girls, with an age of 14.2±1.2 years and an average number of dislocations of 5.3±1.1 times. In the control group which was treated by arthroscopic riveting with line, there were 13 boys and 7 girls, with an age of 13.8±1.3 years and an average number of dislocations of 5.5±1.2 times. The 2 groups were compared in terms of visual analogue score (VAS), Q-angle, knee motion, Lysholm score and Kujala score of the knee at the last follow-ups.@*Results@#The 2 groups were comparable due to insignificant differences in preoperative general data between them (P>0.05). The observation and control groups were followed up for 13.3±1.2 months and 12.9±1.2 months, respectively, showing no significant difference between them(P>0.05). At the last follow-ups, the observation group had a significantly lower VAS score (2.2±0.8 pints), a significantly smaller Q-angle (14.5°±1.2°), significantly larger knee motion (30.3°±3.8°), and significantly higher Lysholm (91.6±5.3 points) and Kujala scores (93.2±2.8 points) than the control group (4.3±1.1 points, 17.8°±1.6°, 23.4°±3.4°, 81.4±4.4 points and 82.0±5.4 points, respectively) (all P<0.05).@*Conclusion@#In the treatment of habitual patellar dislocation, lateral retinacular release plus medial patellofemoral ligament reconstruction can lead to improvements in knee function and clinical symptoms and better clinical outcomes than arthroscopic riveting with line.
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Objective To compare the clinical efficacy between arthroscopic riveting with line and lateral retinacular release plus medial patellofemoral ligament reconstruction in the treatment of habitual patellar dislocation.Methods A retrospective study was conducted of the 40 children with habitual patellar dislocation who had been treated at Department of Pediatric Orthopaedics,Foshan Hospital of Traditional Chinese Medicine from January 2016 to December 2016.They were divided evenly into an observation group and a control group according to the treatment methods (n =20).In the observation group which was treated by lateral retinacular release plus medial patellofemoral ligament reconstruction,there were 14 boys and 6 girls,with an age of 14.2 ± 1.2 years and an average number of dislocations of 5.3 ± 1.1 times.In the control group which was treated by arthroscopic riveting with line,there were 13 boys and 7 girls,with an age of 13.8 ± 1.3 years and an average number of dislocations of 5.5 ± 1.2 times.The 2 groups were compared in terms of visual analogue score (VAS),Q-angle,knee motion,Lysholm score and Kujala score of the knee at the last follow-ups.Results The 2 groups were comparable due to insignificant differences in preoperative general data between them (P ＞ 0.05).The observation and control groups were followed up for 13.3 ± 1.2 months and 12.9 ± 1.2 months,respec-tively,showing no significant difference between them(P ＞ 0.05).At the last follow-ups,the observation group had a significantly lower VAS score (2.2 ± 0.8 pints),a significantly smaller Q-angle (14.5°± 1.2°),significantly larger knee motion (30.3° ± 3.8°),and significantly higher Lysholm (91.6 ± 5.3 points) and Kujala scores (93.2 ±2.8 points) than the control group (4.3 ± 1.1 points,17.8°± 1.6°,23.4°±3.4°,81.4 ±4.4 points and 82.0 ± 5.4 points,respectively) (all P ＜ 0.05).Conclusion In the treatment of habitual patellar dislocation,lateral retinacular release plus medial patellofemoral ligament reconstruction can lead to improvements in knee function and clinical symptoms and better clinical outcomes than arthroscopic riveting with line.