Flexible intramedullary nails with traction versus plaster cast for treating femoral shaft fractures in children: comparative retrospective study / Hastes intramedulares flexíveis com tração versus aparelho gessado para o tratamento de fraturas diafisárias do fêmur em crianças: estudo comparativo retrospectivo

Femoral fractures are common in children between 2 and 12 years of age, and 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as conservative treatment. However, in some situations, a surgical approach is recommended. The objective here was to compare treatments for femoral shaft fractures using intramedullary nails (titanium elastic nails, TEN) versus traction and plaster casts in children. The hypothesis was that TEN might provide better treatment, with good clinical results in comparison with plaster casts.

This retrospective comparative study was conducted in a public university hospital.

Sixty children with femoral fractures were evaluated; 30 of them underwent surgical treatment with TEN and 30 were treated conservatively using plaster casts. The patients' ages ranged from 5 to 13 years (mean of 9 years).

The mean duration of hospitalization was nine days for the surgical group and 20 days for the conservative group. The incidence of overgrowth in the patients treated with TEN was 60.0% and, for those treated conservatively, 13.3%. Partial weight-bearing was allowed after 3.5 weeks in the surgical group and after 9.6 weeks in the conservative group. New hospitalization was required for 90.0% in the surgical group and 16.7% in the conservative group. Patients treated with plaster casts presented higher incidence of complications, such as loss of reduction.

The surgical method presented better results for children. .

Fraturas femorais são comuns em crianças entre 2 e 12 anos de idade, e 75% das lesões acometem a diáfise. Tração seguida de aparelho gessado (“gesso”) é universalmente aceita como tratamento conservador. Entretanto, em algumas situações o tratamento cirúrgico é recomendado. O objetivo foi comparar o tratamento de fraturas diafisárias do fêmur com hastes intramedulares (titanium elastic nails, TEN) com tração e gesso em crianças. A hipótese era de que TEN pode ser melhor tratamento, com bons resultados clínicos em comparação com o gesso.

Este estudo retrospectivo e comparativo foi conduzido num hospital público universitário.

Sessenta crianças com fraturas de fêmur foram avaliadas, 30 delas foram submetidas a tratamento cirúrgico com TEN e 30 foram tratadas de forma conservadora usando gesso. A idade dos pacientes variou de 5 a 13 anos (média de 9 anos).

O tempo médio de internação foi de 9 dias para o grupo cirúrgico e 20 dias para o grupo conservador. A incidência de crescimento excessivo nos pacientes tratados com TEN foi de 60,0% e, para aqueles tratados de forma conservadora, 13,3%. Sustentação parcial de peso foi permitida após 3,5 semanas no grupo cirúrgico e após 9,6 semanas no grupo conservador. Houve 90,0% de novas internações no grupo cirúrgico e 16,7% no grupo conservador. Pacientes tratados com gesso apresentaram maior incidência de complicações, tais como perda de redução.

Influencia del envejecimiento, la marca y la ubicación de las fibras de refuerzos en la resistencia felxural de la resina compuesta Gradia® / Age influence, brand and location of reinforcement fibers in the resistance of the composite resin felxural Gradia®

La incorporación de fibras de refuerzo a resinas compuestas se ha convertido en una alternativa de tratamiento protésico altamente conservador. De esta investigación fue evaluar la resistencia flexural (RF) de una resina compuesta indirecta reforzada con tres diferentes marcas comerciales de fibras de vidrio, variando su ubicación y sometidas a envejecido físico ó químico. Se fabricaron 98 especímenes de resina compuesta Gradia™ (GC-America Inc.) de 22 mm x 2 mm x 3 mm; a 14 muestras no se les colocó fibras (SF), se almacenaron en agua destilada por 60 días, luego se subdividieron en dos grupos de 7 muestras,G1 - SFA y G2 - SFT el cual se sometió a termociclado (3000 ciclos de 5°/55°C en intervalos de 1 min); las otras 84 muestras se reforzaron fibras unidireccionales: 42 muestras para ser almacenadas en agua por 60 días (CFA), divididas en dos sub-grupos de 21, en relación a la ubicación de la fibra en la zona de compresión (CFAC) ó tracción (CFAT); finalmente en tres grupos de 7, dependiendo de la marca; Fibrex-Lab® (Angelus) los grupos G3 - CFACFLab y G6 - CFATFLab, FibreKor® (Jeneric/Penton) los grupos G4 - CFACFKor y G7 - CFATFKor y Vectris® (Ivoclar/Vivadent) los grupos G5 - CFACVectris y G8 - CFATVectris. Las 42 restantes después del almacenamiento en agua se sometieron al termociclado , se dividieron en dos subgrupos de 21, en relación a la ubicación de la fibra en la zona de compresión (CFTC) ó de tracción (CFTT); finalmente se dividió en tres grupos de 7, entonces Fibrex-Lab® conformó los grupos G9 - CFTCFLab y G12 - CFTTFLab, FibreKor® los grupos G10 - CFTCFKor y G13 - CFTTFKor y Vectris® los grupos G11 - CFTCVectris y G14 - CFTTVectris. Las muestras fueron sometidas a la prueba de flexión de tres puntos hasta su fractura, en maquina de pruebas universales (Shimadzu AGS-J) a una velocidad de 1mm/min. Los datos fueron recolectados, tabulados en hoja de cálculo y luego analizados con un estadístico de t de student....

The incorporation of reinforce fibers to composite has turned into an alternative of high conservative prosthetic treatment. The aim of this study was to evaluate the flexure strength (RF) of a indirect reinforce composite using three fiber glass commercial brands, varying the location and submitted to physical o chemical aging. 98 specimen were made of 22 mm x 2 mm x 3 mm Gradia™ resin compound (GC-America Inc.); 14 samples were not reinforce with fiber glass (SF), They were store in distilled water for 60 days then divided in 2 groups of 7 samples, G1 - SFA and G2 - SFT was thermocycled (3000 cycles of 5 °/55°C in intervals of 1 min); the other 82 samples were reinforce with unidirectional fibers: 42 to be stored in distilled water for 60 days (CFA), divided in 2 subgroups of 21, in relation with the localization of the fiber on the compression zone (CFAC) or traction (CFAT); Finally divided in 3 groups of 7, depending on the brand; Fibrex-Lab® (Angelus) the groups G3 - CFACFLab and G6 - CFATFLab, FibreKor® (Jeneric/Penton) the groups G4 - CFACFKor and G7 - CFATFKor and Vectris® (Ivoclar/Vivadent) the groups G5 - CFACVectris and G8 - CFATVectris. The remaining 42 samples after storage in water were submitted to thermocycling, divided in 2 subgroups of 21, in relation with the localization of the fiber on the compression zone (CFTC) or traction (CFTT); Finally divided in 3 groups of 7 then G9 was conformed Fibrex-Lab® CFTCFLab and G12 - CFTTFLab, FibreKor® the groups G10 - CFTCFKor and G13 - CFTTFKor and Vectris® the groups G11 - CFTCVectris and G14 - CFTTVectris. The samples were submitted to the three points flexion test until fracture, in a universal testing machine (Shimadzu AGS-J) to a speed of 1mm/min. The information was gathered, tabulated in spreadsheet and then analyzed with a statistician t of student to determine differences between the groups without fibers and 3 factors ANOVA on the reinforced groups for the varying location...