A COMPARATIVE STUDY ON TWO FIXATION METHODS FOR BENIGN LONG BONE PATHOLOGICAL FRACTURES IN CHILDREN_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANGXiaodong , TANGXueyang , JIANGXin ,  LIULijun

Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding?author：

LIULijun, Email: l1964@126.com

Keywords：

Long bone fracture; Pathological fracture; Elastic intramedullary nail; Locking compression plate; Child

DOI：

10.7507/1002-1892.20150153

Video：

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Objective To compare the effectiveness of locking compression plate and elastic intramedullary nail for the treatment of benign long bone pathological fractures in children, so as to provide the evidence for clinical treatment. Methods Seventy-two children with long bone pathological fractures who accorded with the inclusion criteria between January 2005 and July 2013 were randomly divided into 2 groups. Fracture was fixed with elastic intramedullary nail in 33 cases (group A) and with locking compression plate in 39 cases (group B). There was no significant difference in sex, age, body mass index, primary lesion, location of fracture, side of fracture, and interval between injury and operation between 2 groups (P>0.05). Results Group A had shorter operation time, less intraoperative blood loss, and less overall costs than group B, showing significant differences (P<0.05). Primary healing of incision was obtained. All the patients were followed up 1-7 years (mean, 3.4 years). Tumor lesions disappeared and the pathological fracture healed after operation by X-ray film observation, and group A had faster fracture healing time than group B (P<0.05). There was no loosening and displacement of internal fixation, bone resorption, and bone defect nonunion in 2 groups. Recurrence was found in 2 cases (6.1%) of group A and 3 cases (7.7%) of group B, showing no significant difference (χ²=0.074, P=0.580). Re-fracture was found in 1 patient with tibial bone cyst of group B after 3 months of operation, and healed after 1 year of open reduction and internal fixation. According to X-ray film and comprehensive function evaluation of shoulder, elbow, hip, knee, and ankle, the results were all excellent in 2 groups at last follow-up. Conclusion Elastic intramedullary nail fixation should be the first choice, and locking compression plate should be the second choice for children with benign long bone pathological fractures.

Citation： YANGXiaodong, TANGXueyang, JIANGXin, LIULijun. A COMPARATIVE STUDY ON TWO FIXATION METHODS FOR BENIGN LONG BONE PATHOLOGICAL FRACTURES IN CHILDREN. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(6): 712-716. doi: 10.7507/1002-1892.20150153 Copy

1.	Mankin HJ, Trahan CA, Fondren G, et al. Non-ossifying fibroma, fibrous cortical defect and Jaffe-Campanacci syndrome:a biologic and clinical review. Chir Organi Mov, 2009, 93(1):1-7.
2.	劉偉, 張世謙, 吳濱奇, 等. 鎖定接骨板聯合同種異體骨治療四肢長骨良性骨腫瘤伴病理性骨折. 哈爾濱醫科大學學報, 2012, 46(5):496-498.
3.	張澤華, 張帥, 羅飛, 等. 同種異體骨植骨聯合鎖定加壓鋼板治療四肢良性骨腫瘤及類瘤病變的隨訪研究. 第三軍醫大學學報, 2014, 36(11):1213-1216.
4.	羅雷茗, 魯曉波, 葛建華, 等. 彈性髓內釘內固定術治療兒童肱骨良性病變并病理性骨折. 中國修復重建外科雜志, 2013, 27(1):21-24.
5.	劉云鵬. 骨與關節損傷和疾病的診斷分類及功能評定標準. 北京:清華大學出版社, 2002:199-241.
6.	Saraph V, Linha WE. Modem treatment of pathological fractures in children. Injury, 2005, 36(1):64-74.
7.	Mik G, Arkader A, Manteghi A, et al. Results of a minimally invasive technique for treatment of unicameral bone cysts. Clin Orthop Relat Res, 2009, 467(11):2949-2954.
8.	劉艷成, 胡永成, 夏群, 等. 腫瘤致四肢長骨病理性骨折的治療選擇:異體骨重建、內植物重建還是假體置換? 中國組織工程研究與臨床康復, 2010, 14(22):4139-4143.
9.	Karaman I, Halici M, Kafadar IH, et al. Mid-term results of the elastic intramedullary nailing in paediatric long bone shaft fractures:a prospective study of 102 cases. J Pediatr Orthop B, 2014, 23(3):212-220.
10.	Flinck M, von Heideken J, Janarv PM, et al. Biomechanical comparison of semi-rigid pediatric locking nail versus titanium elastic nails in a femur fracture model. J Child Orthop, 2015, 9(1):77-84.
11.	Ligier JN, Metaizeau JP, Prévot J, et al. Elastic stable intramedullary nailing of femoral shaft fractures in children. J Bone Joint Surg (Br), 1988, 70(1):74-77.
12.	陳慶玉, 彭磊, 張偉, 等. 鈦制彈性穩定性髓內針治療兒童鎖骨干骨折近期療效觀察. 中華小兒外科雜志, 2011, 32(6):438-443.
13.	Tarng YW, Yang SW, Fang YP, et al. Surgical management of uncomplicated midshaft clavicle fractures:a comparison between titanium elastic nails and small reconstruction plates. J Shoulder Elbow Surg, 2012, 21(6):732-740.
14.	Ippolito E, Bray EW, Corsi A, et al. Natural history and treatment of fibrous dysplasia of bone:a mulitcenter clinicopathologic study promoted by the European Pediatric Orthopaedic Society. J Pediatr Orthop B, 2003, 12(3):155-177.
15.	Rapp M, Svoboda D, Wessel LM, et al. Elastic Stable Intramedullary Nailing (ESIN), Orthoss^? and Gravitational Platelet Separation-System(GPS^?):an effective method of treatment for pathologic fractures of bone cysts in children. BMC Musculoskelet Disord, 2011, 12:45.
16.	Atesok K, Liebergall M, Sucher E, et al. Treatment of pathological humeral shaft fractures with unreamed humeral nail. Ann Surg Oncol, 2007, 14(4):1493-1498.
17.	Knorr P, Schmittenbecher PP, Dietz HG, et al. Elastic stable intramedullary nailing for the treatment of complicated juvenile bone cysts of the humerus. Eur J Pediatr Surg, 2003, 13(1):44-49.
18.	Berger L, Fischerauer S, Wei? B, et al. Unlocked and locked elastic stable intramedullary nailing in an ovine tibia fracture model:a biomechanical study. Mater Sci Eng C Mater Biol Appl, 2014, 40:267-274.

1. Mankin HJ, Trahan CA, Fondren G, et al. Non-ossifying fibroma, fibrous cortical defect and Jaffe-Campanacci syndrome:a biologic and clinical review. Chir Organi Mov, 2009, 93(1):1-7.
2. 劉偉, 張世謙, 吳濱奇, 等. 鎖定接骨板聯合同種異體骨治療四肢長骨良性骨腫瘤伴病理性骨折. 哈爾濱醫科大學學報, 2012, 46(5):496-498.
3. 張澤華, 張帥, 羅飛, 等. 同種異體骨植骨聯合鎖定加壓鋼板治療四肢良性骨腫瘤及類瘤病變的隨訪研究. 第三軍醫大學學報, 2014, 36(11):1213-1216.
4. 羅雷茗, 魯曉波, 葛建華, 等. 彈性髓內釘內固定術治療兒童肱骨良性病變并病理性骨折. 中國修復重建外科雜志, 2013, 27(1):21-24.
5. 劉云鵬. 骨與關節損傷和疾病的診斷分類及功能評定標準. 北京:清華大學出版社, 2002:199-241.
6. Saraph V, Linha WE. Modem treatment of pathological fractures in children. Injury, 2005, 36(1):64-74.
7. Mik G, Arkader A, Manteghi A, et al. Results of a minimally invasive technique for treatment of unicameral bone cysts. Clin Orthop Relat Res, 2009, 467(11):2949-2954.
8. 劉艷成, 胡永成, 夏群, 等. 腫瘤致四肢長骨病理性骨折的治療選擇:異體骨重建、內植物重建還是假體置換? 中國組織工程研究與臨床康復, 2010, 14(22):4139-4143.
9. Karaman I, Halici M, Kafadar IH, et al. Mid-term results of the elastic intramedullary nailing in paediatric long bone shaft fractures:a prospective study of 102 cases. J Pediatr Orthop B, 2014, 23(3):212-220.
10. Flinck M, von Heideken J, Janarv PM, et al. Biomechanical comparison of semi-rigid pediatric locking nail versus titanium elastic nails in a femur fracture model. J Child Orthop, 2015, 9(1):77-84.
11. Ligier JN, Metaizeau JP, Prévot J, et al. Elastic stable intramedullary nailing of femoral shaft fractures in children. J Bone Joint Surg (Br), 1988, 70(1):74-77.
12. 陳慶玉, 彭磊, 張偉, 等. 鈦制彈性穩定性髓內針治療兒童鎖骨干骨折近期療效觀察. 中華小兒外科雜志, 2011, 32(6):438-443.
13. Tarng YW, Yang SW, Fang YP, et al. Surgical management of uncomplicated midshaft clavicle fractures:a comparison between titanium elastic nails and small reconstruction plates. J Shoulder Elbow Surg, 2012, 21(6):732-740.
14. Ippolito E, Bray EW, Corsi A, et al. Natural history and treatment of fibrous dysplasia of bone:a mulitcenter clinicopathologic study promoted by the European Pediatric Orthopaedic Society. J Pediatr Orthop B, 2003, 12(3):155-177.
15. Rapp M, Svoboda D, Wessel LM, et al. Elastic Stable Intramedullary Nailing (ESIN), Orthoss^? and Gravitational Platelet Separation-System(GPS^?):an effective method of treatment for pathologic fractures of bone cysts in children. BMC Musculoskelet Disord, 2011, 12:45.
16. Atesok K, Liebergall M, Sucher E, et al. Treatment of pathological humeral shaft fractures with unreamed humeral nail. Ann Surg Oncol, 2007, 14(4):1493-1498.
17. Knorr P, Schmittenbecher PP, Dietz HG, et al. Elastic stable intramedullary nailing for the treatment of complicated juvenile bone cysts of the humerus. Eur J Pediatr Surg, 2003, 13(1):44-49.
18. Berger L, Fischerauer S, Wei? B, et al. Unlocked and locked elastic stable intramedullary nailing in an ovine tibia fracture model:a biomechanical study. Mater Sci Eng C Mater Biol Appl, 2014, 40:267-274.

Chinese Journal of Reparative and Reconstructive Surgery

A COMPARATIVE STUDY ON TWO FIXATION METHODS FOR BENIGN LONG BONE PATHOLOGICAL FRACTURES IN CHILDREN

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