Fracture Table Application for Pediatric Femur Fractures: Incidence and Risk Factors Associated With Adverse Outcomes.

BACKGROUND:
Flexible elastic nails, submuscular plating, and rigid locked intramedullary nails are common methods of fixation for pediatric femur fractures (PFF) in which the fracture table is used to aid reduction. Little is known about complications associated with fracture table application in PFF. The purpose of this study was to determine the incidence and risk factors associated with adverse outcomes related to fracture table application for the treatment of PFF.

METHODS:
A retrospective chart review of all children (younger than 18 y) treated for a femur fracture with the use of the fracture table between 2004 and 2015 at a single tertiary pediatric hospital was performed. Data on demographics, mechanism of injury, treatment modality, radiographic characteristics, and fracture table-related complications were gathered. Complications of interest included nerve palsy, skin breakdown/ulceration, vascular injury, and compartment syndrome. Penalized likelihood logistic regression was used to determine risk factors associated with adverse outcomes.

RESULTS:
In total, 260 patients were included. There were 8 patients with nerve palsies related to positioning and traction on the fracture table (1 bilateral and 6 ipsilateral peroneal nerve palsies, 1 contralateral tibial nerve palsy; incidence of 3.1%). No other fracture table-related complications were recorded. Patients who developed a nerve palsy were significantly heavier (78.7 vs. 44.3 kg, P< 0.001) and had a significantly longer mean surgical time (188.6 vs. 117.0 min, P< 0.001). Multivariate analysis demonstrated weight to be the only significant risk factor for complications, with a 5% increase in odds of complication with each additional kilogram (odds ratio, 1.05; confidence interval, 1.03-1.08; P< 0.001).

CONCLUSIONS:
Nerve palsy related to the use of the fracture table during the fixation of PFF occurred in 3.1% of patients in our series. Patients who developed nerve palsies were significantly heavier and had significantly longer surgical times. Although the use of the fracture table for fixation of PFF is safe, every effort should be made to minimize time in traction to avoid iatrogenic nerve palsy, particularly in heavier children (>80 kg).

LEVEL OF EVIDENCE:
Level III.