Systematic Reviews
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2017; 8(8): 638-643
Published online Aug 18, 2017. doi: 10.5312/wjo.v8.i8.638
Ipsilateral femur and tibia fractures in pediatric patients: A systematic review
Jason B Anari, Alexander L Neuwirth, B David Horn, Keith D Baldwin
Jason B Anari, Alexander L Neuwirth, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19102, United States
B David Horn, Keith D Baldwin, Children’s Hospital of Philadelphia, Philadelphia, PA 19103, United States
Author contributions: All four authors contribute equally to this paper.
Conflict-of-interest statement: The authors have no direct financial conflicts of interest to disclose. One or more of the authors has received funding outside of the submitted work from Journal of Bone and Joint Surgery (KDB), Pfizer (KDB), and Synthes Trauma (KDB).
Data sharing statement: All available data can be obtained by contacting the corresponding author.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Keith D Baldwin, MD, MPH, MSPT, Children’s Hospital of Philadelphia, 24th and Civic Center Boulevard, Philadelphia, PA 19103, United States. baldwink@email.chop.edu
Telephone: +1-856-4040653
Received: December 11, 2016
Peer-review started: December 13, 2016
First decision: February 17, 2017
Revised: February 25, 2017
Accepted: March 23, 2017
Article in press: March 24, 2017
Published online: August 18, 2017
Processing time: 242 Days and 21.9 Hours
Abstract
AIM

To better understand how pediatric floating knee injuries are managed after the wide spread use of new orthopaedic technology.

METHODS

We searched EMBASE, COCHRANE and MEDLINE computerized literature databases from the earliest date available in the databases to February 2017 using the following search term including variants and pleural counterparts: Pediatric floating knee. All studies were thoroughly reviewed by multiple authors. Reference lists from all articles were scrutinized to identify any additional studies of interest. A final database of individual patients was assembled from the literature. Univariate and multivariate statistical tests were applied to the assembled database to assess differences in outcomes.

RESULTS

The English language literature contains series with a total of 97 pediatric patients who sustained floating knee injuries. Patients averaged 9.3 years of age and were mostly male (73). Approximately 25% of the fractures were open injuries, more tibia (27) than femur (10). Over 75% of the fractures of both the tibia and the femur involved the diaphysis. More than half (52) of the patients were treated non-operatively for both fractures. As a sequela of the injury 32 (33%) patients were left with a limb length discrepancy, 24 (25%) patients had lengthening of the injured limb at follow up, while 8 (8%) had shortening of the affected limb. Infection developed in 9 patients and 3 had premature physeal closure. Younger patients were more likely to be treated non-operatively (P < 0.001) and patients treated with operative intervention had statistically significant shorter hospital length of stays (P = 0.001).

CONCLUSION

Given the predominance of non-operative management in published studies, the available literature is not clinically relevant since the popularization of internal fixation for pediatric long-bone fractures

Keywords: Pediatrics; Femur; Tibia; Fracture; Floating knee

Core tip: Advances in orthopaedic technology and implants have dramatically changed the management of femur and tibia fractures in children, when treated in isolation. No current day study, however, has examined the effects of this advancement on the higher energy pediatric floating knee injury. This systematic review indicates a gap in the literature and the need for further investigation.