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Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_7 | Pages 5 - 5
1 Jul 2020
Schaeffer E Sanatani G Habib E Bone J Mulpuri K
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Paediatric femoral fractures are a common result of significant trauma, and always require intervention. Hip spica casting, traction, and surgical fixation can all be used to treat these fractures. This variety in treatment options leads to a vast potential for variability in management decisions among surgeons and has prevented effective comparative studies to show which treatment methods provide optimal outcomes for patients. The purpose of this study was to identify practice variability in management and follow-up and assess patient outcomes to aid in the development of a comprehensive, prospective, evidence-based pathway for the management of paediatric femoral fractures.

A retrospective chart review was performed of all patients treated surgically for isolated femoral fractures during a six year period at a single tertiary care paediatric centre. Patients were identified from a surgical database and were included if there was no pre-existing pathology and no history of previous femoral fracture. Demographic data, operative details, post-operative management, and clinical outcomes were collected. Radiographic images and reports were analyzed to determine fracture classification and imaging parameters. Variability in treatment among eight surgeons was assessed, including number of follow-up appointments and length of follow-up. Patient demographics and follow up measures were summarised for each surgeon and between surgeon variability was assessed with linear models.

In total, 138 femoral fractures in 134 patients (101 male, 33 female) were included in analysis. Of these patients, 55 had right femoral fractures, 76 left, and three bilateral (one bilateral patient had three distinct femoral fractures). Of 138 total fractures, 131 were of the diaphysis of the femur. 14 patients sought initial surgical treatment at our institution but received follow-up management elsewhere. Across all patients, median follow-up time was 32.8 weeks (0–201.4) with a median of three follow-up visits (0–26) in that period. Mean number of follow-up clinic visits ranged from 3 to 4.8 among surgeons, and mean length of follow-up ranged from 31.8 to 62.3 weeks.

No significant differences in follow-up between surgeons were found, but small sample sizes are a likely contributing factor. Summary statistics show large ranges in most variables and differences in patient demographics between surgeon groups. The large ranges in follow-up time and visit number suggest a lack of consensus on optimal management for paediatric femoral fractures. Further prospective study examining long-term functional and quality of life outcomes will be required to identify and develop optimized management guidelines.


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_7 | Pages 11 - 11
1 Jul 2020
Schaeffer E Ghoto A Ahmad D Habib E Mulpuri K
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Systematic reviews (SR) can provide physicians with effective means to further strengthen their practice and identify gaps in clinical knowledge. The focus of any SR is to identify the current state of evidence for a given treatment or condition, with the hopes of providing the best interventional methods physicians can base their practice on. In paediatric orthopaedics, high-level studies are lacking, thus potentially limiting the effectiveness of SRs in the field. There isn't one specific way to qualify research on its effectiveness, but there has been gradual enhancement in finding ways to identify a successful and reproducible study. The purpose of this study was to evaluate the quality of paediatric orthopaedic SRs, and highlight aspects of these SRs that have contributed to improved outcomes.

A literature review was performed in EMBASE, MEDLINE and Cochrane databases to identify pre-existing systematic reviews that have been published in five well-known orthopaedic journals between 2007 and 2017. SRs were included if the study population was between 0 and 18 years of age. Selected articles had an AMSTAR checklist applied in order to score the studies on their quality and methodology. Articles were independently reviewed by two reviewers to determine the extent of AMSTAR guidelines fulfillment.

A total of 40 SRs were identified and reviewed, 20 of which partially or completely fulfilled AMSTAR guidelines. There was no disagreement between reviewers as to which of the analyzed articles have successfully reflected the checklist.

Only 20/40 SRs analyzed at least partially fulfilled AMSTAR guidelines. One of the weaknesses identified in the reviewed papers so far is the lack of justification for the chosen study designs for SRs and what strategy was used to decide on the exclusion of articles. There needs to be clear-cut criteria that mark studies to be included and excluded in a comprehensive systematic review. Further improvements are required to ensure that full details on the involvement of papers and the success rates regarding each interventional method are included in order to strengthen the quality of SRs across the paediatric orthopaedic literature.