Original scientific paper

https://doi.org/10.20471/acc.2020.59.04.15

Treatment of Pediatric Femoral Fractures in the City of Zagreb

Anko Antabak ; Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia
Nikolina Boršćak ; University of Zagreb, School of Medicine, Zagreb, Croatia
Marija Čagalj ; University of Zagreb, School of Medicine, Zagreb, Croatia
Renato Ivelj ; Zagreb Children’s Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croati
Igor Bumči ; Zagreb Children’s Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
Dino Papeš ; Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia
Stanko Ćavar ; Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia
Marko Bogović ; Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia
Krešimir Bulić ; Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia
Tomislav Luetić ; Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia

Abstract

Femur fractures in children can be treated with a number of operative and conservative
methods. Numerous factors determine which method is optimal for a specific fracture. The aim
of this research was to analyze distribution of femur fractures in children living in the urban communities
of Zagreb and Zagreb County by localization, type and frequency of treatment methods used
according to age and fracture mechanism. The research included 103 children aged up to 18 years,
treated for femur fractures at the Zagreb University Hospital Centre and Zagreb Children’s Hospital.
Data were collected from these institutions and a retrospective study covered the 2010-2015 period.
The cause of fracture and diagnosis were coded with the help of the International Statistical Classification
of Diseases and Related Health Problems. Operative treatment was applied in 55% of cases,
which is contrary to previous researches. The highest incidence of femur fractures was recorded in the
0- to 4-year age groups, accounting for 49.1% of all fractures. These fractures mostly occurred due to
falls and were more often treated with non-operative methods. All other age groups were mostly
treated with operative methods. Coxofemoral immobilization and traction were used as non-operative
methods, whereas flexible intramedullary nailing was the most frequently used operative method. The
treatment depended on age, complexity of the fracture, fracture type, fragment displacement, and
associated injuries. The cause was also an important factor on choosing the treatment method. Nonoperative
treatment was mostly used for fractures caused by falls (64.71% of cases due to falls) and
operative treatment was mostly used for fractures caused by traffic accidents (79.4% of cases due to
traffic accidents). It is a wide-known opinion that the best treatment for femur fractures in children is
non-operative treatment. However, recent studies have shown that the use of operative methods in
femur fracture treatment is growing. Our cohort of children treated during a five-year period (2010-
2015) also underwent operative treatment more often than non-operative one. Two non-operative and
eight operative methods were used. With such a large number of methods, it is clear that there is no
unique method for all fractures. However, it is clear that the trend of using operative treatment is connected
to the perennial trend of considerable sociodemographic and socioeconomic changes in urban
settings such as Zagreb. Lifestyle changes directly affect the prevalence of femur fractures among
children, as well as approach to treatment choice. General opinion is that most of fractures that occur
at an early age can be treated with non-operative methods. Our research on femur fractures in children
confirmed this rule. The youngest age group that had the highest incidence of fractures (49.1% of all
fractures) was treated with non-operative methods in 75% of cases. Operative methods prevailed in
other age groups. Similar results have been published by other authors. In conclusion, nearly half of all
femur fractures (49.1%) occurred at a young age (0-4 years). Diaphysis fractures were most common.
Most of the fractures that occurred during the 2010-2015 period were treated with operative methods,
mostly in children aged 5-9 years. Out of eight different operative methods, elastic stable intramedullary
osteosynthesis was most frequently used (60%). Coxofemoral immobilization and traction were
used as non-operative methods.

Keywords

Femur; Fracture; Child; Treatment

Hrčak ID:

254087

URI

https://hrcak.srce.hr/254087

Publication date:

1.12.2020.

Article data in other languages: croatian

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