Klin Padiatr 2019; 231(04): 199-205
DOI: 10.1055/a-0892-4365
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Overhead-Extension für die Therapie der isolierten Femurfraktur des Kleinkindes – Was lernt man von den Eltern

Patients under 4 years old treated with overhead extension for isolated femoral fractures – lessons learned concerning parents’ satisfaction
Ferdinand Wagner
1   Klinikum der Universität München, Kinderchirurgische Klinik und Poliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität, München, Germany
2   Institute of Health and Biomedical Innovation, Regenerative Medicine, Brisbane, Australia
3   Dr. von Hauner Children’s Hospital, Department of Pediatric Surgery, Munich, Germany
,
Viktoria Schütz
1   Klinikum der Universität München, Kinderchirurgische Klinik und Poliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität, München, Germany
3   Dr. von Hauner Children’s Hospital, Department of Pediatric Surgery, Munich, Germany
,
Jochen Hubertus
1   Klinikum der Universität München, Kinderchirurgische Klinik und Poliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität, München, Germany
3   Dr. von Hauner Children’s Hospital, Department of Pediatric Surgery, Munich, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
09 May 2019 (online)

Zusammenfassung

Hintergrund Die konservative Therapie ist der Standard bei Unter-4-jährigen mit Femurfraktur. Um die Zufriedenheit der Eltern mit dieser aufwändigen Behandlung zu verbessern haben wir wichtige Einflussfaktoren auf diesen wichtigen Behandlungsaspekt untersucht. Patienten: 42 Fälle von Kindern unter 4 Jahren, mit Femurfraktur und Overheadextension-Therapie (OHE) wurden analysiert.

Methode Unser Standardverfahren beinhaltet die 10-tägige OHE mit anschließender Becken-Bein-Gips-Behandlung (BBG). Röntgenbilder wurden bezgl. des Heilverlaufs analysiert. Die Eltern wurden mittels eines pseudonymisierten Fragebogens über ihre Erfahrungen befragt.

Ergebnisse Die Art der Fraktur wurde 73.3% der Eltern „verständlich und detailliert“ erklärt. 23.3% gaben an, dass „viele Fragen unbeantwortet” blieben. 70% der Eltern bemerkten Verhaltensauffälligkeiten bei Ihrem Kind, 63.3% berichteten von therapie-spezifischen Problemen. 86.7% der Eltern waren mit dem Behandlungserfolg zufrieden, 80% mit der Art der Therapie und 73.3% würden die OHE erneut wählen. Spearman-Korrelations-Analysen fanden eine signifikante Korrelation zwischen der generellen Elternzufriedenheit und einem hohen Grad an Aufklärung bzgl. der Art der Fraktur. Eltern, welche Probleme während der Visite ansprechen konnten zeigten eine signifikant höhere Zufriedenheit.

Diskussion Die meisten Gründe für eine Unzufriedenheit der Eltern waren in Verbindung mit Kommunikationsproblemen zu sehen.

Schlussfolgerung Eine gute Evaluierung während der Visite, gute Kommunikation mit den Ärzten sowie gute pflegerische Hilfestellung beeinflussen die Zufriedenheit der Familien erheblich.

Abstract

Background Conservative options are the standard for treatment of femoral fractures for patients under the age of 4 years. We investigated possible factors influencing the satisfaction of the parents in order to improve their experience. Patients: We analyzed 42 cases of children under the age of 4 years treated with overhead extension therapy (OHE) for femoral fracture.

Methods Our protocol requires transition to spica cast treatment (SCT) and discharge from the hospital after the initial 10-day OHE. X-rays were analyzed for fracture healing. A pseudonymized questionnaire was sent to the parents in order to evaluate their experiences during the treatment.

Results The nature of the fracture was explained to 73.3% of the parents in a way that was “understandable and in detail”. However, 23.3% stated that “many questions were not answered”. Seventy percent of parents noticed behavioral abnormalities during treatment, and 63.3% reported treatment-specific problems. Additionally, 86.7% of parents were satisfied with the therapy outcome, 80% were content with the type of therapy, and 73.3% would choose OHE again. We found a high Spearman correlation between general satisfaction and parents who felt well informed. There was also a strong correlation between high general satisfaction and the opportunity for any problems to be discussed and addressed during the medical rounds.

Discussion The reasons for nonsatisfaction were primarily due to communication problems.

Conclusion Thorough evaluation during medical rounds, communication with healthcare professionals and care provided by the nurses affects the contentment of the families significantly.

Ferdinand Wagner and Viktoria Schütz contributed equally to this work.


Supplementary

 
  • References

  • 1 Bickham RS, Ranganathan K, Wombacher NR. et al. speech perceptions and health-related quality of life among children with cleft lip and palate. J Craniofac Surg 2017; 28: 1264-1268
  • 2 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; 86: 1152-1157
  • 3 Casas J, Gonzalez-Moran G, Albinana J. Femoral fractures in children from 4 years to 10 years: conservative treatment. J Pediatr Orthop B 2001; 10: 56-62
  • 4 d'Ollonne T, Rubio A, Leroux J. et al. Early reduction versus skin traction in the orthopaedic treatment of femoral shaft fractures in children under 6 years old. J Child Orthop 2009; 3: 209-215
  • 5 Day AS, Lemberg DA, Nichol A. et al. Generalisability of the inflammatory bowel disease knowledge inventory device to assess disease-related knowledge in Australian children. J Paediatr Child Health 2014; 50: 591-595
  • 6 Deutsche Gesellschaft für Kinderchirurgie, Surgery GSoP. AWMF Leitlinie Femurschaftfraktur im Kindesalter S1-Leitlinie 006/016: Femurschaftfraktur im Kindesalter
  • 7 Dietz HG, Joppich I, Marzi I. et al. [Treatment of femoral fractures in childhood. Consensus Report of the 19th Meeting of the Child Traumatology Section of the DGU, Munich, 23-24 June 2000]. Der Unfallchirurg 2001; 104: 788-790
  • 8 Di Fazio R, Vessey J, Zurakowski D. et al. Incidence of skin complications and associated charges in children treated with hip spica casts for femur fractures. Journal of Pediatric Orthopedics 2011; 31: 17-22
  • 9 Doupnik SK, Hill D, Palakshappa D. et al. parent coping support interventions during acute pediatric hospitalizations: A meta-analysis. Pediatrics 2017; 140: 3 Epub 2017 Aug 17
  • 10 Elliott AD, Bartel AF, Simonson D. et al. Is the internet a reliable source of information for patients seeking total ankle replacement?. J Foot Ankle Surg 2015; 54: 378-381
  • 11 Ghisi GL, Britto R, Motamedi N. et al. Disease-related knowledge in cardiac rehabilitation enrollees: correlates and changes. Patient Educ Couns 2015; 98: 533-539
  • 12 Gogineni K, Shuman K, Chinn D. et al. Making cuts to medicare: the views of patients, physicians, and the public. J Clin Oncol 2015; 33: 846-853
  • 13 Heffernan MJ, Gordon JE, Sabatini CS. et al. Treatment of femur fractures in young children: a multicenter comparison of flexible intramedullary nails to spica casting in young children aged 2–6 years. Journal of Pediatric Orthopedics 2015; 35: 126-129
  • 14 Heideken J, Svensson T, Blomqvist P. et al. Incidence and trends in femur shaft fractures in Swedish children between 1987 and 2005. Journal of Pediatric Orthopedics 2011; 31: 512-519
  • 15 Hendriks M, Rademakers J. Relationships between patient activation, disease-specific knowledge and health outcomes among people with diabetes; a survey study. BMC Health Serv Res 2014; 14: 393
  • 16 Hinton RY, Lincoln A, Crockett MM. et al. Fractures of the femoral shaft in children. Incidence, mechanisms, and sociodemographic risk factors. The Journal of Bone and Joint Surgery American volume 1999; 81: 500-509
  • 17 Jauquier N, Doerfler M, Haecker FM. et al. Immediate hip spica is as effective as, but more efficient than, flexible intramedullary nailing for femoral shaft fractures in pre-school children. J Child Orthop 2010; 4: 461-465
  • 18 Jones GL, McClellan W, Raman S. et al. parental perceptions of obesity and obesity risk associated with childhood acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2017; 39: 370-375
  • 19 Jones J, Nowacki AS, Greene A. et al. investigating parent needs, participation, and psychological distress in the children's hospital. Hosp Pediatr 2017; 7: 385-394
  • 20 Lee YH, Lim KB, Gao GX. et al. Traction and spica casting for closed femoral shaft fractures in children. Journal of Orthopaedic Surgery 2007; 15: 37-40
  • 21 Lieber J, Schmittenbecher P. Developments in the treatment of pediatric long bone shaft fractures. European journal of pediatric surgery : Official Journal of Austrian Association of Pediatric Surgery [et al.]=Zeitschrift fur Kinderchirurgie 2013; 23: 427-433
  • 22 Mansour 3rd AA, Wilmoth JC, Mansour AS. et al. Immediate spica casting of pediatric femoral fractures in the operating room versus the emergency department: Comparison of reduction, complications, and hospital charges. Journal of Pediatric Orthopedics 2010; 30: 813-817
  • 23 Nafei A, Teichert G, Mikkelsen SS. et al. Femoral shaft fractures in children: An epidemiological study in a Danish urban population, 1977-86. Journal of Pediatric Orthopedics 1992; 12: 499-502
  • 24 Ramo BA, Martus JE, Tareen N. et al. Intramedullary nailing compared with spica casts for isolated femoral fractures in 4 and 5-year-old children. The Journal of Bone and Joint Surgery American volume 2016; 98: 267-275
  • 25 Rewers A, Hedegaard H, Lezotte D. et al. Childhood femur fractures, associated injuries, and sociodemographic risk factors: A population-based study. Pediatrics 2005; 115: e543-e552
  • 26 Rosenbaum AJ, Uhl RL, Rankin EA. et al. Social and Cultural Barriers: Understanding Musculoskeletal Health Literacy: AOA Critical Issues. J Bone Joint Surg Am 2016; 98: 607-615
  • 27 Sakkalou E, Sakki H, O'Reilly MA. et al. Parenting stress, anxiety, and depression in mothers with visually impaired infants: A cross-sectional and longitudinal cohort analysis. Dev Med Child Neurol 2018; 60: 290-298
  • 28 Schneidmueller D, Kraft C, Buhren V. et al. [Growth behavior after femoral shaft fractures: Feasibility of patient therapy targets]. Der Unfallchirurg 2014; 117: 1099-1104
  • 29 Strohm PC, Schmittenbecher PP. [Femoral shaft fractures in children under 3 years old. Current treatment standard]. Der Unfallchirurg 2015; 118: 48-52
  • 30 Wagner F, Brendel J, Dingeldey E. et al. [Disease-specific Knowledge in Conservative Treatment of Adolescent Idiopathic Scoliosis]. Z Orthop Unfall 2018; DOI: 10.1055/s-0043-125091.
  • 31 Wright JG, Wang EE, Owen JL. et al. Treatments for paediatric femoral fractures: A randomised trial. Lancet 2005; 365: 1153-1158