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The treatment of femoral shaft fractures in children: a systematic overview and critical appraisal of the literature Wright JGCan J Surg 2000[Jun]; 43 (3): 180-9OBJECTIVE: Through a critical systematic overview of the literature on the treatment of pediatric femoral shaft fractures to determine if any method of treatment can be recommended over others. DATA SOURCES: A MEDLINE search was performed for all cohort and randomized clinical trials for the years 1966 to 1996. STUDY SELECTION: Of 1217 identified articles, 15 cohort studies (where 2 or more treatments were compared in the same study) reported the treatment of children with femoral fractures. DATA EXTRACTION: Information was abstracted and articles rated for quality blind to author, institution and journal. DATA SYNTHESIS: Children having early application of a hip spica cast had an average hospital stay of 11 days (range from 5 to 29 days), average charges of $5784 (range from $590 to $11,800), average rates of limb-length discrepancy (greater than 2 cm) of 3% (range from 0 to 25%), angulatory malunion rates (greater than 10 degrees) of 8% (range from 0 to 19%), and rotational malunion rates (greater than 10 degrees) of 13% (range from 0 to 5%). The costs and malunion rates of early application of a hip spica cast were lower than for traction. Internal fixation (including intramedullary nails) had low angulatory malunion rates compared with early application of a hip spica cast but higher over-lengthening rates (greater than 2 cm) of 25% (range from 5% to 100%) and mean rotational malunion rates (greater than 10 degrees) of 25% (range from 11% to 32%). CONCLUSION: Early application of a hip spica cast had lower costs and malunion rates than traction.|Adolescent[MESH]|Age Factors[MESH]|Casts, Surgical/adverse effects/economics[MESH]|Child[MESH]|Child, Preschool[MESH]|Cohort Studies[MESH]|Femoral Fractures/complications/economics/*therapy[MESH]|Fracture Fixation, Internal/adverse effects/economics[MESH]|Fractures, Malunited/economics/etiology[MESH]|Hospital Charges/statistics & numerical data[MESH]|Humans[MESH]|Infant[MESH]|Leg Length Inequality/economics/etiology[MESH]|Length of Stay/statistics & numerical data[MESH]|Patient Selection[MESH]|Randomized Controlled Trials as Topic[MESH]|Research Design[MESH]|Rotation[MESH]|Traction/adverse effects/economics[MESH]|Treatment Outcome[MESH] |
