Hemodynamic Instability of Femur with Closed Fractures in Children

Main Article Content

Ahmed Alkhuzai

Keywords

Hematocrit, Hemodynamic, Hemodilution, Fracture femur

Abstract

Background: This prospective study examines whether hypovolemic shock occurs in kids with traumatic solitary closed femur fractures. The common symptom ranges from minor to severe trauma in children and adolescents.
Methods: From September 20, 2015, to August 15, 2018, children with traumatic femoral fractures were the subject of prospective descriptive research. One hundred individuals were hospitalized at the Sulaimaniyah Emergency Hospital with isolated closed fractures of the femur in children. The goal was to rapidly fix the old criteria for blood transfusions that did not adequately indicate a replacement with actual blood requirements. Measurements were taken based on the children’s clinical parameters, such as pulse rate, systolic blood pressure, respiratory rate, skin capillary refill time, and mental status, rather than hemoglobin or hematocrit concentration. Open fractures, bilateral fracture femur in children, and any fracture associated with trauma to the body organ as associated injury were all excluded.
Results: When compared to widely recognize normal vital sign readings, the 100 patients with these types of fractures who satisfied the study's inclusion criteria showed no signs of hemodynamic instability. The study excluded any patients with hemoglobin levels below 8.5 g/dl, equivalent vital signs between the two groups, and a 2-6% incidence of hemodynamic instability among numerous injured children with femoral fractures.
Conclusion: In children with traumatic solitary femoral fractures, there was no sign of hemodynamic instability. Early hemoglobin and hematocrit ratios were unreliable. They did not significantly change or increase at an abnormal rate. Isolated closed femoral fractures were confirmed to be hemodynamically stable based on vital sign measures in patients with femur bone fractures after ruling out bilateral femur fractures, concomitant damage, or individuals.

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References

1. Sahlin Y. Occurrence of fractures in a defined population: a 1-yearstudy.Injury. 1990 May1; 21(3): 158-60.
2. Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J. Titanium elasticnails for pediatricfemur fractures: a multi center study of early results with analysis of complications. Journal of Pediatric Orthopaedics. 2001 Jan 1;21(1):4-8.
3. Flynn JM, Luedtke L, Ganley TJ, Pill SG. Titanium elastic nails for pediatric femur fractures: lessons from the learning curve. American journal of orthopedics (Belle Mead, NJ). 2002 Feb; 31(2):71.
4. Von Heideken J, Svensson T, Blomqvist P, Haglund-Åkerlind Y, Janarv PM. Incidence and trends in femur shaft fractures in Swedish children between 1987and 2005. Journal of Pediatric Orthopaedics. 2011 Jul 1; 31(5):512-9.
5. Anglen JO, ChoiL. Treatment options in pediatric femoral shaft fractures. Journal of orthopaedic trauma. 2005 Nov 1; 19(10):724-33.
6. Kuremsky MA, Frick SL. Advances in the surgical management of pediatric femoral shaft fractures. Current opinion in pediatrics. 2007 Feb1;19(1):51-7.
7. Wright JG, Wang EE, Owen JL, Stephens D, Graham HK, Hanlon M, Nattrass GR, Reynolds RA, Coyte P. Treatments for pediatric femoral fractures: a randomized trial. The Lancet. 2005 Mar 26; 365(9465): 1153-8.
8. Kobbe P, Micansky F, Lichte P, Sellei RM, Pfeifer R, Dombroski D, Lefering R, Pape HC, TraumaRegister DGU. Increased morbidity and mortality after bilateral femoral shaft fractures: my thor reality in the era of damage control?. Injury. 2013Feb 1; 44(2):221-5.
9. Willett K, Al-Khateeb H, Kotnis R, Bouamra O, Lecky F. Risk of mortality: the relationship with associated injuries and fracture treatment methods in patients with unilateral or bilateral femoral shaft fractures. Journal of Trauma and Acute Care Surgery.2010 Aug1; 69(2): 405-10.
10. Nahm NJ, Como JJ, Wilber JH, Vallier HA. Early appropriate care: definitive stabilization of femoral fractures within 24 hours of injury is safe in most patients with multiple injuries. Journal of Trauma and Acute Care Surgery. 2011 Jul 1; 71(1): 175-85.
11. Lichte P, Weber C, Sellei RM, Hildebrand F, Lefering R, Pape HC, Kobbe P, Trauma Register DGU. Are bilateral tibia shaft fractures associated with an increased risk for adverse outcome?. Injury. 2014 Dec 1; 45(12): 1985-9.
12. Naqvi SZ, Askari R, Ashraf U. Management of simultaneous bilateral femur fractures in a tertiary care hospital: a retrospective review. National Journal of Health Sciences. 2017 Feb; 2(1):35.
13. Giannoudis PV, CohenA, Hinsche A, Stratford T, Matthews SJ, Smith RM. Simultaneous bilateral femoral fractures: systemic complications in 14 cases. International Orthopedics. 2000 Nov 1; 24(5): 264-7.
14. Ippolito JA, Marciano GF, Sabharwal S. Treatment of pediatric closed femoral shaft
fractures: A decline in use of external fixators over the last decade. Journal of Limb Lengthening & Reconstruction. 2017 Jul 1; 3(2): 107.
15. Murphy R, Kelly DM, Moisan A, Thompson NB, Warner Jr WC, Beaty JH, Sawyer JR. Transverse fractures of the femoral shaft area better predictor of non-accidental traumain young children than spiral fractures are. JBJS. 2015 Jan 21; 97(2): 106-11.
16. Kocher MS, Sink EL, Blasier RD, Luhmann SJ, Mehlman CT, Scher DM, Matheney T, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of pediatric diaphyseal femur fracture. JBJS. 2010 Jul 21; 92(8): 1790-2.
17. Lynch JM, Gardner MJ, Gains B. Hemodynamic significance of pediatric femur fractures. Journal of pediatric surgery. 1996 Oct 1; 31(10): 1358-1361.
18. Sutherland DH, Olshen RI, Cooper L, Woo SL. The development of mature gait. Journal of BoneJoint Surg Am. 1980 Apr 1; 62(3): 336-53.
19. Loder RT, Feinberg JR. Epidemiology and mechanisms of femur fractures in children. Journal of Pediatric Orthopedics. 2006 Sep 1;26(5):561-6.
20. Rasool MN, Govender S, Naidoo KS. Treatment of femoral shaft fractures in children by early spicacasting. South African Medical Journal. 1989; 76(8).
21. Burton VW, Fordyce AJ. Immobilization of femoral shaft fractures in childrenaged2–10years.Injury. 1972Jan 1;4(1):47-53.
22. Anderson WA. The significance of femoral fractures in children. Annals of emergency medicine. 1982 Apr1;11(4):174-7.
23. Hui C, Joughin E, Goldstein S, Cooper N, Harder J, Kiefer G, Parsons D, Howard J. Femoral fractures in children younger than three years: the role of non accidental injury. Journal of Pediatric Orthopedics. 2008 Apr1; 28(3): 297-302.
24. Bridgman S, Wilson R. Epidemiology of femoral fractures in children in the West Midlands region of England 1991 to 2001. The Journal of bone and joint surgery. British volume. 2004 Nov; 86(8): 1152-7.