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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 10, 1361-1366.
doi: 10.1302/0301-620X.88B10.17517  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Titanium elastic nailing of fractures of the femur in children

PREDICTORS OF COMPLICATIONS AND POOR OUTCOME

L. A. Moroz, BA, Medical Student1; F. Launay, MD, Orthopaedic Surgeon2; M. S. Kocher, MPH, MD, Orthopaedic Surgeon3; P. O. Newton, MD, Orthopaedic Surgeon4; S. L. Frick, MD, Orthopaedic Surgeon5; P. D. Sponseller, MD, Orthopaedic Surgeon6; and J. M. Flynn, MD, Orthopaedic Surgeon1

1 Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, 2nd Floor Wood Building, 34th Street & Civic Center Boulevard, Philadelphia, Pennsylvania 19104-4399, USA.
2 Department of Orthopaedic Surgery, Timone Children’s Hospital, 264 St-Pierre Street, 13005 Marseille, France.
3 Department of Orthopaedic Surgery, Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, Massachussetts 02115, USA.
4 Department of Orthopaedic Surgery, Children’s Hospital San Diego, 3030 Children’s Way, San Diego, California 92123, USA.
5 Department of Orthopaedic Surgery, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, North Carolina 28232, USA.
6 Department of Orthopaedic Surgery, Johns Hopkins Hospital, 601 North Carolina Street, Baltimore, Maryland 21287-0882, USA.

Correspondence should be sent to Dr J. M. Flynn; e-mail: flynnj{at}email.CHOP.edu

Between 1996 and 2003 six institutions in the United States and France contributed a consecutive series of 234 fractures of the femur in 229 children which were treated by titanium elastic nailing. Minor or major complications occurred in 80 fractures. Full information was available concerning 230 fractures, of which the outcome was excellent in 150 (65%), satisfactory in 57 (25%), and poor in 23 (10%). Poor outcomes were due to leg-length discrepancy in five fractures, unacceptable angulation in 17, and failure of fixation in one. There was a statistically significant relationship (p = 0.003) between age and outcome, and the odds ratio for poor outcome was 3.86 for children aged 11 years and older compared with those below this age. The difference between the weight of children with a poor outcome and those with an excellent or satisfactory outcome was statistically significant (54 kg vs 39 kg; p = 0.003). A poor outcome was five times more likely in children who weighed more than 49 kg.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General