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About Sickkids
About SickKids

March 29, 2005

SickKids researchers determine most effective treatment for broken thighbones

TORONTO - Researchers at The Hospital for Sick Children (Sick Kids) have conducted the world’s first multi-centre randomized clinical trial to evaluate the effectiveness of two standard treatments for treating fractures of the femur (thighbone) in children. This research is reported in the March 26, 2005 issue of the medical journal The Lancet.

“Many standard medical procedures and treatments have never been evaluated in a scientific manner. Instead, most medical practice is based on impressions,” said Dr. James Wright, the study’s lead author and principal investigator, and surgeon-in-chief, staff orthopaedic surgeon and senior scientist at Sick Kids. “The only way to truly know what is the best form of treatment is to conduct a randomized clinical trial. By properly evaluating common health-care interventions, we will be able to save the health-care system resources in the long term.”

Children, aged four to 10 years, admitted to four paediatric hospitals (Sick Kids, Toronto, Canada; Royal Children’s Hospital, Melbourne, Australia; Starship Children’s Hospital, Auckland, New Zealand; Children’s Hospital, Los Angeles, USA), between 1994 and 2000 were randomly treated with two standard treatments for femoral fractures: either early application of a hip spica cast (a cast that goes from the hip to the toes) or external fixation (a series of pins into the bone that are connected to a bar outside of the leg.)

Of the 101 patients enrolled in the study, 56 received hip spica treatment and 45 received the external fixator. The children were assessed to see if their bones healed in a proper position and for physical function and behaviour, as well as for the children’s and parents’ satisfaction with the treatment. The external fixator was found to be the superior treatment, in that it had a lower rate of fracture malunion, where the bone did not heal the proper position. The researchers found no difference between the treatments in terms the children’s and parents’ happiness with treatment, or with the children’s physical function and behaviour.

“By conducting this trial, we found that many of common impressions regarding treatments for femoral fractures to be untrue. For example, we found that a child’s bone will not straighten over time if it doesn’t heal in the proper position initially. We also found that it is a misperception that parents and children do not like external fixation, which is a more invasive form of treatment compared with a cast,” said Dr. Wright, who is also holder of the Robert B. Salter Chair in Paediatric Surgical Research, and a professor of Surgery, Public Health Sciences and Health Policy, Management and Evaluation at the University of Toronto.

“Since we conducted this study, a new method of treating femur fractures has become popular in North America – flexible intramedullary nails. Next, we hope to conduct a randomized trial to compare the flexible nails with the external fixator, which are both invasive fixation techniques for treating broken femurs,” added Dr. Wright.

This research was supported by the Canadian Institutes of Health Research (CIHR), the Canadian Orthopaedic Foundation and Sick Kids Foundation. Dr. Wright was the recipient of a CIHR Investigator Award.

The Hospital for Sick Children, affiliated with the University of Toronto, is Canada’s most research-intensive hospital and the largest centre dedicated to improving children’s health in the country. Its mission is to provide the best in family-centred, compassionate care, to lead in scientific and clinical advancement, and to prepare the next generation of leaders in child health.

For more information, please contact:

Public Affairs
The Hospital for Sick Children
555 University Avenue
Suite 1742, Public Affairs, First floor Atrium
Toronto, ON
M5G 1X8
Canada
Phone: 416-813-5058
Fax: 416-813-5328