Strategies in Trauma and Limb Reconstruction

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VOLUME 15 , ISSUE 3 ( September-December, 2020 ) > List of Articles


Hybrid Fixation for Paediatric Femoral Supracondylar Fracture during Circular External Fixation of the Lower Limb

Yoshinobu Oka, Wook-Cheol Kim, Takashi Yoshida, Masashi Nakase, Yoshihiro Kotoura, Atsushi Nishida, Hiroaki Wada, Toshiharu Shirai, Kenji Takahashi

Keywords : Children, Circular external fixation, Femur fracture

Citation Information : Oka Y, Kim W, Yoshida T, Nakase M, Kotoura Y, Nishida A, Wada H, Shirai T, Takahashi K. Hybrid Fixation for Paediatric Femoral Supracondylar Fracture during Circular External Fixation of the Lower Limb. 2020; 15 (3):179-183.

DOI: 10.5005/jp-journals-10080-1454

License: CC BY-NC-SA 4.0

Published Online: 01-12-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Aim: To describe the novel hybrid fixation technique for paediatric femoral supracondylar fracture during circular external fixation of the lower limb. Background: The Ilizarov external fixator is commonly used for various orthopaedic conditions. Difficulties associated with external fixation have previously been described. A fall while using a circular external fixator can cause ipsilateral fracture. Such fractures are ideally treated conservatively, but it is difficult to fix the frame itself. No study has reported the treatment of paediatric femoral supracondylar fracture during circular external fixation. Herein, we describe a novel hybrid fixation technique that was successfully used to treat paediatric femoral supracondylar fracture in three paediatric patients with circular external fixators. Technique: The fracture was manually manipulated and reduced by slight hyperextension of the lower extremity under general anaesthesia. After confirmation of good reduction, a stockinette, a cast padding, and a thin core cast were applied to the ipsilateral thigh. The hinge parts were attached to the medial and lateral sides of the proximal ring. The rods were connected to the medial and lateral hinges, and the half ring was connected to the ventral side of the proximal end. Under fluoroscopic confirmation, the thin core cast of the thigh and rods were connected by cast rolled in a figure-of-eight manner. The hinges were locked with the knee joint slightly flexed. Conclusion: The minimally invasive hybrid fixation technique enables conservative treatment of paediatric femoral supracondylar fracture during circular external fixation of the lower limb with no complications, and early exercise and recovery. Clinical significance: This novel hybrid fixation technique will be an effective method for paediatric femoral supracondylar fracture in patients with a circular external fixator.

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  1. Tafazal S, Madan SS, Ali F, et al. Management of paediatric tibial fractures using two types of circular external fixator: Taylor spatial frame and Ilizarov circular fixator. J Child Orthop 2014;8(3):273–279. DOI: 10.1007/s11832-014-0583-2.
  2. Zenios M, Oyadiji SO. Effect of asymmetrical configuration of pins in the TSF external fixator used for tibial lengthening in a pediatric population. J Pediatr Orthop 2014;34(6):618–624. DOI: 10.1097/BPO.0000000000000194.
  3. Demiralp B, Ege T, Kose O, et al. Reconstruction of intercalary bone defects following bone tumor resection with segmental bone transport using an Ilizarov circular external fixator. J Orthop Sci 2014;19(6):1004–1011. DOI: 10.1007/s00776-014-0632-1.
  4. Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res 1990;250(250):81–104. DOI: 10.1097/00003086-199001000-00011.
  5. De Bastiani G, Aldegheri R, Renzi-Brivio L, et al. Limb lengthening by callus distraction (callotasis). J Pediatr Orthop 1987;7(2):129–134. DOI: 10.1097/01241398-198703000-00002.
  6. Simpson AH, Kenwright J. Fracture after distraction osteogenesis. J Bone Joint Surg Br 2000;82(5):659–665. DOI: 10.1302/0301-620x.82b5.9945.
  7. Launay F, Younsi R, Pithioux M, et al. . Fracture following lower limb lengthening in children: a series of 58 patients. Orthop Traumatol Surg Res 2013;99(1):72–79. DOI: 10.1016/j.otsr.2012.08.005.
  8. Jones CP, Youngblood CSA, Waldrop N, et al. Tibial stress fracture secondary to half-pins in circular ring external fixation for Charcot foot. Foot Ankle Int 2014;35(6):572–577. DOI: 10.1177/1071100714531229.
  9. Blair JA, Owens JG, Saucedo J, et al. Skeletal trauma research consortium (STReC). Functional rehabilitation with a foot plate modification for circular external fixation. Foot Ankle Int 2013;34(6):890–897. DOI: 10.1177/1071100713483975.
  10. Ebraheim NA, Kelley LH, Liu X, et al. Periprosthetic distal femur fracture after total knee arthroplasty: a systematic review. Orthop Surg 2015;7(4):297–305. DOI: 10.1111/os.12199.
  11. Memisoglu K, Atmaca H, Kesemenli CC. Treatment of femur fractures in preschool children with double pin technique: immediate incorporated hip spica casting by two K-wires. Indian J Surg 2015;77(Suppl 2):635–639. DOI: 10.1007/s12262-013-0952-y.
  12. Parikh SN, Nathan ST, Priola MJ, et al. Elastic nailing for pediatric subtrochanteric and supracondylar femur fractures. Clin Orthop Relat Res 2014;472(9):2735–2744. DOI: 10.1007/s11999-013-3240-z.
  13. Sabharwal S. Role of Ilizarov external fixator in the management of proximal/distal metadiaphyseal pediatric femur fractures. J Orthop Trauma 2005;19(8):563–569. DOI: 10.1097/
  14. Abdelgawad AA, Kanlic EM. Pediatric distal femur fixation by proximal humeral plate. J Knee Surg 2013;26(Suppl 1):S45–S49. DOI: 10.1055/s-0031-1299658.
  15. Hohmann E, Birkholtz F, Glatt V, et al. The “Road to Union” protocol for the reconstruction of isolated complex high-energy tibial trauma. Injury 2017;48(6):1211–1216. DOI: 10.1016/j.injury.2017.03.018.
  16. Delport PH, Van Audekercke R, Martens M, et al. Conservative treatment of ipsilateral supracondylar femoral fracture after total knee arthroplasty. J Trauma 1984;24(9):846–849. DOI: 10.1097/00005373-198409000-00013.
  17. Sochart DH, Hardinge K. Nonsurgical management of supracondylar fracture above total knee arthroplasty. Still the nineties option. J Arthroplasty 1997;12(7):830–834. DOI: 10.1016/s0883-5403(97)90016-4.
  18. Nasr AM, Mc Leod I, Sabboubeh A, et al. Conservative or surgical management of distal femoral fractures. A retrospective study with a minimum five year follow-up. Acta Orthop Belg 2000;66(5):477–483.
  19. Rickert KD, Hosseinzadeh P, Edmonds EW. What's new in pediatric orthopaedic trauma: the lower extremity. J Pediatr Orthop 2018;38(8):e434–e439. DOI: 10.1097/BPO.0000000000001209.
  20. Bor N, Rozen N, Dujovny E, et al. Fixator-assisted plating in pediatric supracondylar femur fractures. Glob Pediatr Health 2019;6:2333794X19843922. DOI: 10.1177/2333794X19843922.
  21. Skaggs DL, Leet AI, Money MD, et al. Secondary fractures associated with external fixation in pediatric femur fractures. J Pediatr Orthop 1999;19(5):582–586. DOI: 10.1097/01241398-199909000-00005.
  22. Gregory P, Pevny T, Teague D. Early complications with external fixation of pediatric femoral shaft fractures. J Orthop Trauma 1996;10(3):191–198. DOI: 10.1097/00005131-199604000-00007.
  23. Smith NC, Parker D, McNicol D. Supracondylar fractures of the femur in children. J Pediatr Orthop 2001;21(5):600–603. DOI: 10.1097/01241398-200109000-00009.
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