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- Talk
- 13/09/2021
- UK
Risk of Complications following Surgical Fixation of Femoral Diaphyseal Fractures in Children Aged 4 to 12 Years: A Systematic Review and Meta-analysis
Description
In this presentation, Cat Daly, a core surgical trainee, discusses the management of femoral shaft fractures in children, which have an incidence of 5.8 per 100,000 in the UK. She highlights the different treatment options based on the child’s size and local medical preferences. Cat mentions that while younger children are often treated with hip spica immobilization, adolescents may undergo procedures more akin to adults, using plates or nails. Between ages 4 to 12, however, the optimal management remains unclear, as indicated by a Cochrane review.
Despite NICE and the American Academy of Orthopedic Surgeons recommending flexible intramedullary nails, Cat's hypothesis is that a systematic review might reinforce this choice. She outlines her methodology, which involved a prospectively registered systematic review and strict inclusion criteria, excluding certain types of fractures to ensure a fair comparison of complications associated with various treatment modalities: flexible intramedullary nails, external fixation, and plate fixation.
Ultimately, her study includes 28 studies, revealing the highest risk of complications with external fixation, while plate fixation indicates a lower complication rate, contrasted against current guidelines promoting nails. She notes the need for clarification on complications and limitations of her review, emphasizing the significant influence of research quality.
Engaging discussing ensues, with Hamish Simpson and other colleagues probing into the implications and limitations of the findings, affirming the necessity of further research to potentially shift surgical practices for treating femoral fractures in the pediatric population.