Session VI - Pediatrics / Spine

Fri., 10/11/13 Pediatrics/Spine, PAPER #71, 4:13 pm OTA 2013

A Prospective Cohort Study of the Adoption of Titanium Elastic Intramedullary Nails for the Treatment of Femur Fractures in Kumasi, Ghana

Tai Holland, BS1; Scott P. Kaiser, MD1; Paa Kwesi Baidoo, MD2; Kate Liddle, BS1;
Dominic Yeboah, MD2; Richard Coughlin, MD1; Dominic Awariyah, MD2;
Peter Konadu, MD2; Raphael Kumah-Ametepey, MD2;
1Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery,
University of California, San Francisco, San Francisco, California, USA;
2Department of Orthopaedic Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana

Background/Purpose: Elastic intramedullary nails (EIN) have been shown to be effective in the treatment of transverse and short oblique femur fractures in children. No studies have compared outcomes of EIN versus skin traction for pediatric femur fractures. At Komfo Anokye Teaching Hospital (KATH), prior to 2010, all pediatric femur fractures were treated with skin traction until union. This study was designed to compare the early results and cost of EIN versus skin traction and determine health-related quality of life (HRQOL) outcomes of children with femur fractures stabilized with EIN.

Methods: This was a prospective observational study of 83 pediatric patients age 3 to 14 years presenting with closed femur fractures at KATH from January to December 2010. Implant costs were borne by the patient’s family. Those who did not purchase implants were treated with skin traction until union, and this comprised the control group. Patient and injury demographics, initial radiographs, postoperative radiographic outcomes, length of stay, and total costs were compared between groups. The child’s HRQOL at 6 months was assessed using the pediatric quality of life inventory (PedsQL).

Results: There was significantly better radiographic alignment in the 45 children treated with elastic nails. Average posttreatment length of stay was 30.8 days in the traction group versus 15.6 days in the EIN group (P = 0.001). Cost of hospitalization was significantly lower in the EIN group(P = 0.039). The mean HRQOL remained significantly lower in total score (63.4) and in all five subscales (physical health, 64.9; psychosocial health, 63.0; emotional functioning, 68.0; social functioning, 68.3; and school functioning, 51.33) than the general population mean at average 6-month follow-up.

Conclusions: In this prospective observational cohort study of pediatric femoral fractures in Kumasi, Ghana, treatment with EIN resulted in superior radiographic outcomes, shorter hospital stay, and decreased hospital cost in comparison to skin traction. At 6 months, HRQOL remained significantly impacted in children who sustained femur fractures stabilized by EIN.

Alphabetical Disclosure Listing

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.