Incidence of Ipsilateral Femoral Neck and Shaft Fractures in Pediatric and Adolescent Patients.

Autor:	Borden TC; University of Texas Health Science Center at Houston, Houston, TX., Haidar LA; University of Texas Health Science Center at Houston, Houston, TX., Vanodia RM; University of Texas Health Science Center at Houston, Houston, TX., Vemu SM; Methodist Hospital System, Houston, TX; and., Dennis GS; University of Texas Health Science Center at Houston, Houston, TX., Mundluru SN; University of Texas Health Science Center at Houston, Houston, TX., Crawford LM; University of Texas Health Science Center at Houston, Houston, TX., Traver JL; University of Texas Health Science Center at Houston, Houston, TX., Younas SA; University of Texas Health Science Center at Houston, Houston, TX., Gary JL; Keck School of Medicine of USC, Los Angeles, CA., Prasarn ML; Methodist Hospital System, Houston, TX; and., Achor TS; University of Texas Health Science Center at Houston, Houston, TX., Munz JW; University of Texas Health Science Center at Houston, Houston, TX., Mansour AA; University of Texas Health Science Center at Houston, Houston, TX.
Jazyk:	angličtina
Zdroj:	Journal of orthopaedic trauma [J Orthop Trauma] 2024 Oct 01; Vol. 38 (10), pp. 541-546.
DOI:	10.1097/BOT.0000000000002872
Abstrakt:	Objectives: To identify the incidence, patient characteristics, and effectiveness of radiographic screening methods for detecting ipsilateral femoral neck and shaft fractures in pediatric and adolescent trauma patients. Design: Retrospective cohort study. Setting: This study was conducted at a tertiary pediatric trauma hospital. Patient Selection Criteria: Patients younger than 18 years treated for a femoral shaft fracture between 2004 and 2018 were reviewed. Pathologic (metabolic bone disease or bone lesion), periprosthetic, and penetrating traumatic femoral shaft fractures were excluded. Outcome Measurements and Comparisons: Patient demographics, mechanisms of injury, treatment methods, and associated injuries were analyzed. Pretreatment x-rays and computed tomography (CT) scans were reviewed for the identification of ipsilateral femoral neck and shaft fractures. Results: Among the 840 pediatric patients included in this study, 4 patients (0.5%) sustained ipsilateral femoral neck and shaft fractures. All the femoral neck fractures were observed in adolescents (aged 13-17 years) and involved in high-energy traumas. In adolescents involved in high-energy trauma, the incidence increased to 1.7%. Pretreatment sensitivity of both x-rays and CT scans was only 50% for the detection of femoral neck fractures. Conclusions: This study reveals that ipsilateral femoral neck and shaft fractures in pediatric patients are rare, occurring in adolescents involved in high-energy trauma. The findings suggest the need for a selective, rather than routine, use of CT scans based on the patient's age and the mechanism of injury. The use of alternative imaging methods such as magnetic resonance imaging should be considered to balance diagnostic accuracy while minimizing radiation exposure. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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