Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis.

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Abstract

[Indexed for MEDLINE] 11. J Pediatr Orthop. 2022 Sep 1;42(8):e828-e832. doi: 10.1097/BPO.0000000000002207. Epub 2022 Jul 14. An Alternative Fixation Option for Subtrochanteric Femur Fractures in Children: Adult Proximal Humerus Plate. Danişman M(1), Özdemir E(2), Dursun G(3), Ayvaz M(3), Yilmaz G(3). Author information: (1)Giresun University Faculty of Medicine, Department of Orthopaedics and Traumatalogy, Giresun. (2)Karabük University Faculty of Medicine, Department of Orthopaedics and Traumatalogy, Karabük. (3)Hacettepe University Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey. BACKGROUND: Subtrochanteric femur fractures are unstable injuries due to strong muscle forces on the proximal femur. The ideal fixation device is controversial in the treatment of subtrochanteric femur fractures in children. The aim of this study is to evaluate the clinical and radiological outcomes of subtrochanteric femur fractures in children treated with an adult proximal humerus plate. METHODS: A total of 9 patients [mean age at surgery, 8.3 years (range: 7 to 12); mean follow-up period, 28.1 months (range: 12 to 56)] who underwent surgery due to a subtrochanteric femur fracture and treated with an adult proximal humerus between January 2017 and December 2021 were retrospectively evaluated. Four of the patients had a pathological fracture associated with a benign bone tumor while 5 patients had a nonpathological fracture. The clinical and radiological outcomes were assessed using the Flynn scoring system at the latest follow-up. Time to union and complications were recorded. RESULTS: All patients demonstrated a solid fusion of the fracture site and were able to bear full weight at the latest follow-up. The mean time to union was 8.2 weeks (range: 6 to 10). Based on the Flynn scoring system at the latest follow-up, seven patients had excellent clinical outcomes and two patients had satisfactory outcomes. Two patients had limb length discrepancy, and one patient had coxa valga and a limb length discrepancy of 16 mm. There were no patients with nonunion, infection, implant failure, osteonecrosis of the femoral head, and heterotopic bone formation. CONCLUSION: This study suggests that the adult proximal humerus plate may be an effective alternative fixation option in the treatment of subtrochanteric femur fractures in children, including pathological fractures. LEVEL OF EVIDENCE: Level IV, Case series. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/BPO.0000000000002207