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.	刘伟, 张世谦, 吴滨奇, 等. 锁定接骨板联合同种异体骨治疗四肢长骨良性骨肿瘤伴病理性骨折. 哈尔滨医科大学学报, 2012, 46(5):496-498.
3.	张泽华, 张帅, 罗飞, 等. 同种异体骨植骨联合锁定加压钢板治疗四肢良性骨肿瘤及类瘤病变的随访研究. 第三军医大学学报, 2014, 36(11):1213-1216.
4.	罗雷茗, 鲁晓波, 葛建华, 等. 弹性髓内钉内固定术治疗儿童肱骨良性病变并病理性骨折. 中国修复重建外科杂志, 2013, 27(1):21-24.
5.	刘云鹏. 骨与关节损伤和疾病的诊断分类及功能评定标准. 北京:清华大学出版社, 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.	刘艳成, 胡永成, 夏群, 等. 肿瘤致四肢长骨病理性骨折的治疗选择:异体骨重建、内植物重建还是假体置换? 中国组织工程研究与临床康复, 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.	陈庆玉, 彭磊, 张伟, 等. 钛制弹性稳定性髓内针治疗儿童锁骨干骨折近期疗效观察. 中华小儿外科杂志, 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, Weiß 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. 刘伟, 张世谦, 吴滨奇, 等. 锁定接骨板联合同种异体骨治疗四肢长骨良性骨肿瘤伴病理性骨折. 哈尔滨医科大学学报, 2012, 46(5):496-498.
3. 张泽华, 张帅, 罗飞, 等. 同种异体骨植骨联合锁定加压钢板治疗四肢良性骨肿瘤及类瘤病变的随访研究. 第三军医大学学报, 2014, 36(11):1213-1216.
4. 罗雷茗, 鲁晓波, 葛建华, 等. 弹性髓内钉内固定术治疗儿童肱骨良性病变并病理性骨折. 中国修复重建外科杂志, 2013, 27(1):21-24.
5. 刘云鹏. 骨与关节损伤和疾病的诊断分类及功能评定标准. 北京:清华大学出版社, 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. 刘艳成, 胡永成, 夏群, 等. 肿瘤致四肢长骨病理性骨折的治疗选择:异体骨重建、内植物重建还是假体置换? 中国组织工程研究与临床康复, 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. 陈庆玉, 彭磊, 张伟, 等. 钛制弹性稳定性髓内针治疗儿童锁骨干骨折近期疗效观察. 中华小儿外科杂志, 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, Weiß 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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