马拉维恩科塔科塔地区医院非手术治疗小儿股骨干骨折的临床和功能结果。

Clinical and functional outcomes of Paediatric femoral shaft fractures managed non-operatively at Nkhotakota District Hospital, Malawi.

机构信息

Nkhotakota District Hospital, Department of Orthopaedics.

Department of surgery, Queen Elizabeth Central Hospital.

出版信息

Malawi Med J. 2021 Mar;33(1):7-14. doi: 10.4314/mmj.v33i1.2.

DOI:10.4314/mmj.v33i1.2

PMID:34422228

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8360290/

Abstract

BACKGROUND

Femoral shaft fracture is a common paediatric injury, managed non-operatively with skin traction in Malawian public hospitals. The clinical and functional outcomes of this treatment modality are unknown in Malawi.

METHODS

We retrospectively identified all children who were managed at Nkhotakota District Hospital with skin traction after sustaining closed femoral shaft fractures from January 1, 2013 to December 31, 2016. We collected demographic characteristics and treatment history from the patient's inpatient medical records, then invited each patient to undergo in-person follow-up clinical and functional assessment.

RESULTS

We identified 149 patients. Gallows traction 26 (17%) and 123 Bucks skin traction (83%). The mean age for Gallows traction was 10 months (95% CI: 8-11), most were males (16, 62%). Fall was the most common cause of injury (19, 73%), and mean hospitalization of 15.8 days (95% CI: 13.8-17.9). Eighteen patients (69%) were followed up at a mean of 4.2 years after discharge, all were full weight bearing, had achieved radiographic fracture union, and had no functional limitations or pain during regular activity. Buck's skin traction mean age was 5.2 years (95% CI: 4.7-5.8), most were males (82, 67%), and fall (85, 69%). We followed up 83 patients (67%) at a mean of 4.1 years after hospital discharge, all of whom had achieved radiographic fracture union. All but one patient were full weight bearing and had normal gait. At follow-up, 14 patients (17%) reported some level of pain, 5 patients reported that their injury limited their return to household chores, and 2 reported that their injury also limited their return to school.

CONCLUSION

Despite the limitations of this study, non-operative management of paediatric femoral shaft fractures at Nkhotakota District Hospital may have good clinical and functional outcomes and minimal complications. A future prospective study may be helpful to confirm these findings.

摘要

背景

股骨干骨折是马拉维公立医院中常见的儿童损伤，采用皮肤牵引进行非手术治疗。这种治疗方式的临床和功能结果在马拉维尚不清楚。

方法

我们回顾性地确定了 2013 年 1 月 1 日至 2016 年 12 月 31 日期间，在恩科塔科塔区医院接受闭合股骨干骨折皮肤牵引治疗的所有儿童患者。我们从患者的住院病历中收集人口统计学特征和治疗史，然后邀请每位患者进行现场随访临床和功能评估。

结果

我们共确定了 149 名患者。其中 26 例采用吊架牵引（17%），123 例采用 Bucks 皮肤牵引（83%）。吊架牵引的平均年龄为 10 个月（95%CI：8-11），大多数为男性（16 例，62%）。坠落伤是最常见的损伤原因（19 例，73%），平均住院时间为 15.8 天（95%CI：13.8-17.9）。18 例（69%）患者在出院后平均 4.2 年进行了随访，所有患者均完全负重，骨折均达到影像学愈合，且在日常活动中无功能受限或疼痛。Bucks 皮肤牵引的平均年龄为 5.2 岁（95%CI：4.7-5.8），大多数为男性（82 例，67%），损伤原因也为坠落伤（85 例，69%）。我们对 83 例（67%）患者在出院后平均 4.1 年进行了随访，所有患者均达到影像学愈合。除 1 例患者外，所有患者均完全负重，步态正常。随访时，14 例（17%）患者报告存在一定程度的疼痛，5 例患者报告其损伤限制了他们重返家务劳动，2 例报告其损伤也限制了他们重返学校。