An Observational Cohort Study of the Adoption of Elastic Stable Intramedullary Nailing for the Treatment of Pediatric Femur Fractures in Kumasi, Ghana

Background In high- and middle-income countries, elastic stable intramedullary nailing (ESIN) is the commonest treatment of femur fractures in children 5–11 years of age. At Komfo Anokye Teaching hospital (KATH) in Kumasi, Ghana, prior to this study all pediatric femur fractures were treated with sk...

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Bibliographic Details
Published in:World journal of surgery 2014-11, Vol.38 (11), p.2818-2824
Main Authors: Kaiser, Scott P., Holland, Tai, Baidoo, Paa Kwesi, Coughlin, Richard C., Konadu, Peter, Awariyah, Dominic, Kumah-Ametepey, Raphael A.
Format: Article
Language:English
Subjects:
Abdominal Surgery
Adolescent
Bone Nails - economics
Cardiac Surgery
Child
Child, Preschool
Cohort Studies
Elastic Stable Intramedullary Nailing
Elastic Titanium Nail
External Fixation
Female
Femoral Fractures - surgery
Femoral Fractures - therapy
Fracture Fixation, Intramedullary - economics
Fracture Fixation, Intramedullary - instrumentation
Fracture Healing
Fracture Pattern
General Surgery
Ghana
Humans
Infant
Length of Stay
Male
Medicine
Medicine & Public Health
Spica Casting
Surgery
Thoracic Surgery
Traction - economics
Treatment Outcome
Vascular Surgery
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Summary:Background In high- and middle-income countries, elastic stable intramedullary nailing (ESIN) is the commonest treatment of femur fractures in children 5–11 years of age. At Komfo Anokye Teaching hospital (KATH) in Kumasi, Ghana, prior to this study all pediatric femur fractures were treated with skin traction to union. This study was designed to report the early results and costs of the adoption of ESIN at KATH to provide data to other low- and middle-income sites considering adoption of this surgical technique. Methods An observational cohort study that included 84 pediatric patients ages 3–14 years presenting with closed femur fractures and treated with either skin traction or ESIN. Multivariate logistic regression was used to compare the rate of treatment success between treatment groups. Results Treatment success (coronal and sagittal angulation less than 10 ° and shortening less than 15 mm at osseous union) was achieved in 92 % of the ESIN group versus 67 % of the skin traction group (odds ratio for ESIN group 9.28 (1.6–54.7); p  = 0.0138). Average length of stay was significantly lower in the ESIN group ( p  = 0.001), but charges to patients were higher in the ESIN group ( p  
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-014-2664-2