Elastic stable intramedullary nailing vs. hip spica casting management for postoperative femoral fractures in children with developmental dysplasia of the hip.

INTRODUCTION

Proximal femoral osteotomy (PFO) produces excellent clinical results for developmental dysplasia of the hip (DDH) in children. Femur fractures in the hips of children after PFO have been reported, and both elastic stable intramedullary nailing (ESIN) and hip spica casting have been used to treat these fractures. Usually, decision-making between ESIN and hip spica casting has been based on the fracture pattern and age. The purpose of this study was to compare the outcomes of elastic stable intramedullary nailing with those of hip spica casting management for postoperative femoral fractures in the hips of children with developmental dysplasia.

METHODS

Ten patients were classified into the ESIN group, whereas eight patients were classified into the hip spica casting group. The age, fracture pattern, average hospitalization, surgical time, and complications were compared between the two groups.

RESULTS

From July 2012 to July 2018, a total of 396 children with DDH were treated at our institution, and 18 patients who presented with postoperative femur fractures were included in the study. There were significant differences in age and fracture pattern (P < 0.001). Conversely, no statistically significant difference was found between the two groups concerning gender and side. Meanwhile, patients with a follow-up time of <24 months or incomplete medical records were excluded from our study. Compared with that in the ESIN (6.4 days), the average length of hospitalization was longer in the hip spica casting group (9.5 days, P < 0.001). The surgical time was shorter in the hip spica casting group (24.8 ± 4.5 min) than in the ESIN group (34.7 ± 5.1 min) (P < 0.05).

CONCLUSION

Our study revealed that the radiological outcomes were generally good after ESIN or hip spica casting. In our study, hip spica casting was suggested for undisplaced femoral fractures in patients aged 2-5 years. In addition, ESIN was a quick and minimally invasive technique for treating displaced femoral fractures in patients aged 5-8 years and prevented secondary displacement.