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Résumé
RÉSUMÉ
Introduction. Femoral shaft fractures (FSF) are common in the paediatric age group. They represent 1.4 to 1.7% of fractures in children and 20% of children hospitalize for fractures. It is a traumatologic emergency, whose diagnosis is clinical and the prognosis is generally good. The aim of the study was to describe the epidemiologic, diagnostic and therapeutic aspects of FSF in children at the Yaounde Gynaeco–Obstetric and Paediatric Hospital (YGOPH). Methods. This was a retrospective descriptive study from 2004 to 2016 and prospective study from November 2016 to February 2017. It was conducted at the paediatric surgical service of the YGOPH. We included patients aged 0 to 15 years of age who were treated in the service, excluding those who were discharged against medical advice. Results. FSF represented 67 (91.8%) of femoral fractures. The mean age was 4.7±4.3 years among which 46 (68.7%) were males. 41 (61.2%) were schooling. The main circumstance of occurrence was road traffic accident 32(47.8%). Clinically, deformity (94%) predominated. (65%) of fractures affected the right limb. The most common radiological sign was: the visibility of the transverse line of fracture (70.1%). Displacement was overlap in 31.3% of cases. The treatment was always orthopaedic (100%). The morbidity was mainly valgus angulation (16.5%). Conclusion. FSF occur mostly in male children of 4.7 years as a result of road traffic accidents. The diagnosis is clinical and the role of plain radiography is to assess fracture line and displacement. The treatment is usually orthopaedic.
ABSTRACT
Introduction. Les fractures de la diaphyse fémorale (FDF) sont fréquentes chez l’enfant. Elles représentent 1.4 à 1.7% des fractures chez l’enfant et 20% des patients hospitalisés. C’est une urgence traumatologique. Le diagnostic est clinique et le pronostic est bon. Le but de l’étude était de décrire les aspects épidémiologiques, diagnostiques et thérapeutiques des fractures de la diaphyse fémorale chez l’enfant à l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé (HGOPY). Méthodologie. Il s’agit d’une étude transversale rétrospective descriptive de 2004 à 2016 et prospective de Novembre 2016 à Févier 2017. Elle a été menée dans le service de chirurgie pédiatrique de l’HGOPY chez les enfants âgés de 15 ans ou moins. Les variables d’intérêt étaient les aspects sociodémographiques, diagnostiques et thérapeutiques des enfants souffrant de fractures de la diaphyse. Résultats. Les FDFs représentaient 67 (91.8%) des fractures fémorales. L’âge moyen était 4.7±4.3 ans parmi lesquels 46 (68.7%) étaient de sexe masculin. 41 (61.2%) étaient scolarisés. La circonstance de survenue la plus fréquente était les accidents de la voie publique 32(47.8%). Cliniquement, la déformation (94%) prédominait. (65%) des fractures étaient à droite. Le trait: (70.1%) transverse prédominait. Le chevauchement (31.3%) était le déplacement le plus fréquent. Le traitement était orthopédique (100%). L’angulation valgus était la morbidité la plus fréquente (16.5%). Conclusion. Les FDFs sont fréquentes chez le garçon de 4.7 ans survenu à la cour d’un accident de la circulation. Le diagnostic est clinique et fait appel à la radiographie standard pour préciser le trait et le déplacement. Le traitement est essentiellement orthopédique.
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##journal.references##
- Saurabh Gupta, Jayasheel Hegde. Prospective study of management of diaphyseal fractures of femur in paediatric age group by titanium Elastic Nailing system. Journal of medical thesis 2014 ; 2(1): 19-23
- Madhuri V, Dutt v, Gahukamble AD, Tharyan P. Intervention for treating femoral shaft fractures in children and adolescents. CDSR. 2014. CD009076
- Mouafo Tambo FF, Bahebeck J, Leckpa Tazo AG, Bob Oyono JM, Sosso MA. Epidémiologie Clinique des Fractures Traumatiques de l’enfant à l’Hôpital Central de Yaoundé: A propos de 226 Cas. 2011. Health Sci. Dis: Vol 12 (1)
- Bob’Oyono JM, Bob’ Abessolo BF, Nyanit Bob D. Fractures fermees isolees de la diaphyse femorale du grand enfant en milieu Africain : comparaison entre le traitement orthopedique et l’embrochage centromedullaire.Health Sci. Dis :Vol15 (3) 2014
- Canavese F, Marengo L, Andreacchio A, Mansour M, Paonessa M, Rousset M, et al. Complications of elastic stable intramedullary nailing of femoral shaft fractures in children weighing fifty kilograms (one hundred and ten pounds) and more. International Orthopaedics (SICOT). 2016 9;40(12):2627–34.
- Catena N, Sénès FM, Riganti S, Boero S. Diaphyseal femoral fractures below the age of six years: Results of plaster application and long term followup. Indian J Orthop. 2014;48(1):30–4.
- Hoffmann CR, Traldi EF, Posser A. Epidemiological study of children diaphyseal femoral fractures. Rev Bras Ortop. 2015 6;47(2):186–90.
- Komlatsè A-NG, Azanledji BM, Abossisso SK, Anani M-AK, Komla G, Hubert T. Elastic stable intramedullary nailing of femoral shaft fractures in children: Particularities and results at Sylvanus Olympio teaching hospital of Lomé, Togo. African JPS. 2014 1;11(1):8.
- Mansoor K, Shahnawaz S, Ahmad A, Arif MM, Hamza M. Epidemiology of childhood fractures in the city of KARACHI. J Ayub Med Coll Abbottabad. 2015 ;27(3):608–12.
- Rapp M, Kaiser MM, Grauel F, Gielok C, Illing P. Femoral shaft fractures in young children (<5 years of age): operative and non-operative treatments in clinical practice. Eur J Trauma Emerg Surg. 2015 3;42(6):719–24.
- Ramprasad ; Sankineani Sukesh Rao ; Naranje Sameer ; Birth-related femoral fracture in newborns: risk factors and management. Journal of children's orthopaedics A. 2012, vol. 6, n° 3, pp. 177-180.
- Murphy R, Kelly DM, Moisan A, Thompson NB, Warner WC, Beaty JH, et al. Transverse Fractures of the Femoral Shaft Are a Better Predictor of Non-accidental Trauma in Young Children Than Spiral Fractures Are. The JBJS. 2015 21;97(2):106 11.
- Akinyoola AL, Orekha OO, Taiwo FO, Odunsi AO. Outcome of non-operative management of femoral shaft fractures in children. Afr J Paediatr Surg. 2011 ;8(1):34–9.
- D’Ollonne T, Rubio A, Leroux J, Lusakisimo S, Hayek T, Griffet J. Early reduction versus skin traction in the orthopaedic treatment of femoral shaft fractures in children under 6 years old. J Child Orthop. 2009 ;3(3):209–15.
- Sagan ML, Datta JC, Olney BW, Lansford TJ, McIff TE. Residual deformity after treatment of pediatric femur fractures with flexible titanium nails. J Pediatr Orthop. 2010 ;30(7):638–43.
- Jauquier N, Doerfler M, Haecker F-M, Hasler C, Zambelli P-Y, Lutz N. Immediate hip spica is as effective as, but more efficient than, flexible intramedullary nailing for femoral shaft fractures in pre-school children. J Child Orthop. 2010 Oct;4(5):461–5.
##journal.references##
Saurabh Gupta, Jayasheel Hegde. Prospective study of management of diaphyseal fractures of femur in paediatric age group by titanium Elastic Nailing system. Journal of medical thesis 2014 ; 2(1): 19-23
Madhuri V, Dutt v, Gahukamble AD, Tharyan P. Intervention for treating femoral shaft fractures in children and adolescents. CDSR. 2014. CD009076
Mouafo Tambo FF, Bahebeck J, Leckpa Tazo AG, Bob Oyono JM, Sosso MA. Epidémiologie Clinique des Fractures Traumatiques de l’enfant à l’Hôpital Central de Yaoundé: A propos de 226 Cas. 2011. Health Sci. Dis: Vol 12 (1)
Bob’Oyono JM, Bob’ Abessolo BF, Nyanit Bob D. Fractures fermees isolees de la diaphyse femorale du grand enfant en milieu Africain : comparaison entre le traitement orthopedique et l’embrochage centromedullaire.Health Sci. Dis :Vol15 (3) 2014
Canavese F, Marengo L, Andreacchio A, Mansour M, Paonessa M, Rousset M, et al. Complications of elastic stable intramedullary nailing of femoral shaft fractures in children weighing fifty kilograms (one hundred and ten pounds) and more. International Orthopaedics (SICOT). 2016 9;40(12):2627–34.
Catena N, Sénès FM, Riganti S, Boero S. Diaphyseal femoral fractures below the age of six years: Results of plaster application and long term followup. Indian J Orthop. 2014;48(1):30–4.
Hoffmann CR, Traldi EF, Posser A. Epidemiological study of children diaphyseal femoral fractures. Rev Bras Ortop. 2015 6;47(2):186–90.
Komlatsè A-NG, Azanledji BM, Abossisso SK, Anani M-AK, Komla G, Hubert T. Elastic stable intramedullary nailing of femoral shaft fractures in children: Particularities and results at Sylvanus Olympio teaching hospital of Lomé, Togo. African JPS. 2014 1;11(1):8.
Mansoor K, Shahnawaz S, Ahmad A, Arif MM, Hamza M. Epidemiology of childhood fractures in the city of KARACHI. J Ayub Med Coll Abbottabad. 2015 ;27(3):608–12.
Rapp M, Kaiser MM, Grauel F, Gielok C, Illing P. Femoral shaft fractures in young children (<5 years of age): operative and non-operative treatments in clinical practice. Eur J Trauma Emerg Surg. 2015 3;42(6):719–24.
Ramprasad ; Sankineani Sukesh Rao ; Naranje Sameer ; Birth-related femoral fracture in newborns: risk factors and management. Journal of children's orthopaedics A. 2012, vol. 6, n° 3, pp. 177-180.
Murphy R, Kelly DM, Moisan A, Thompson NB, Warner WC, Beaty JH, et al. Transverse Fractures of the Femoral Shaft Are a Better Predictor of Non-accidental Trauma in Young Children Than Spiral Fractures Are. The JBJS. 2015 21;97(2):106 11.
Akinyoola AL, Orekha OO, Taiwo FO, Odunsi AO. Outcome of non-operative management of femoral shaft fractures in children. Afr J Paediatr Surg. 2011 ;8(1):34–9.
D’Ollonne T, Rubio A, Leroux J, Lusakisimo S, Hayek T, Griffet J. Early reduction versus skin traction in the orthopaedic treatment of femoral shaft fractures in children under 6 years old. J Child Orthop. 2009 ;3(3):209–15.
Sagan ML, Datta JC, Olney BW, Lansford TJ, McIff TE. Residual deformity after treatment of pediatric femur fractures with flexible titanium nails. J Pediatr Orthop. 2010 ;30(7):638–43.
Jauquier N, Doerfler M, Haecker F-M, Hasler C, Zambelli P-Y, Lutz N. Immediate hip spica is as effective as, but more efficient than, flexible intramedullary nailing for femoral shaft fractures in pre-school children. J Child Orthop. 2010 Oct;4(5):461–5.