National trends in the treatment of femur fractures in the preschool population: Age and geography play a role |
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| Institution: | 1. Department of Hand & Microsurgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, Hunan Province, China;2. Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States;1. Department of Orthopedic Surgery, Allegheny Health Network, 307 Federal St, 2nd floor, Pittsburgh, PA, USA;2. Highmark Health Data Science R&D, 120 Fifth Ave, Pittsburgh, PA, USA;1. Department of Orthopaedics, Chonburi Hospital, Chonburi 20000, Thailand;2. Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;3. Excellence Center in Osteology Research and Training Center (ORTC), Chiang Mai University, Chiang Mai 50200, Thailand;4. Department of Orthopaedics, School of Medicine, Mae Fah Luang University, Chiang Rai 50200, Thailand;1. Consultant Orthopaedic Surgeon. Department of Orthopaedics and Traumatology, Sakarya University Faculty of Medicine, Training and Research Hospital, Adapazar?, Sakarya, Turkey;2. Consultant Orthopaedic Surgeon. Marmara University Pendik Training and Research Hospital, Pendik, ?stanbul 34890, Turkey;3. Consultant Orthopaedic Surgeon. Marmara University Pendik Training and Research Hospital, Pendik, ?stanbul 34890, Turkey;4. Consultant Orthopaedic Surgeon. Department of Orthopaedics and Traumatology, Marmara University Pendik Training and Research Hospital, Pendik, ?stanbul 34890, Turkey;5. Consultant Orthopaedic Surgeon. Department of Orthopaedics and Traumatology, Marmara University Pendik Training and Research Hospital, Pendik, ?stanbul 34890, Turkey;1. New South Wales Newborn & paediatric Emergency Transport Service, Australia;2. University of Sydney, Australia |
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| Abstract: | BackgroundSpica casting and elastic stable intramedullary nailing (ESIN) are options for diaphyseal femur fractures in preschool-age children (ages 3-6 years). Clinical practice guidelines (CPG) are only of moderate or limited strength, which may lead to variation in practice. The purpose of this study is to analyze the epidemiology of children undergoing these procedures in the United States.MethodsThe Pediatric Health Information System, a national database consisting of 49 children's hospitals, was queried for patients between the ages of 3 and 6 years undergoing spica casting or ESIN for a diaphyseal femur fracture between 2011 and 2017. Non-diaphyseal fractures, subjects with associated syndromes or neuromuscular disorders, and pathologic fractures were excluded. Census guidelines were used to categorize hospitals geographically into regions and divisions. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounders.ResultsAnalysis included 4059 subjects. Spica casting was performed in 2878 children (71%) and ESIN in 1181 (29%). The median age of those undergoing spica casting was 3.0 years interquartile range (IQR) 1 year] compared to 5.0 years for ESIN (IQR 2 years; p<0.01). When adjusting for covariates in a multivariate model, each year of increasing age resulted in 4.4 times higher odds that ESIN would be performed (95% CI 4.0-4.8, p<0.01). Compared to the Northeast, a child in the Midwest had 3.6 times higher odds of undergoing ESIN rather than spica casting (95% CI 2.6-5.1, p<0.01). Age at time of ESIN was lowest in the Midwest and highest in the Northeast (4.8±1.0 versus 5.3±0.9 years; p<0.01). There was no variation in the ratio of spica casting to ESIN performed in this age group between 2011 and 2017, including after release of the 2015 CPG.ConclusionsIn the United States, there is substantial variation in the chosen treatment for diaphyseal femur fractures in preschool-age children. ESIN is more likely to be chosen for older children. It is also most likely to be performed in the Midwest and least likely in the Northeast. These findings may have implications in terms of cost and resource utilization and suggest the need for more clinical data to guide surgical indications. |
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