scholarly journals Defining length stability in paediatric femoral shaft fractures treated with titanium elastic nails

2021 ◽  
pp. 1-7
Author(s):  
Alvin K. Shieh ◽  
Augustine M. Saiz Jr ◽  
Kelsey S. Hideshima ◽  
Brian M. Haus ◽  
Holly B. Leshikar
Keyword(s):  
Characteristic Curve ◽  
Treatment Success ◽  
Femoral Shaft ◽  
Intramedullary Nails ◽  
Level Of Evidence ◽  
Fracture Characteristics ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Pattern Length ◽  
Flexible Intramedullary Nails

Introduction Optimal paediatric femoral shaft fracture patterns or lengths amenable to titanium elastic nail stabilization have not been well defined. The purpose of this study is to identify radiographic parameters predictive of treatment failure with flexible intramedullary nails based upon fracture morphology. Methods A retrospective review was performed of all femoral shaft fractures treated with flexible intramedullary nails over a five-year period. All patients with at least six weeks of postoperative radiographic imaging were included. Fracture characteristics included location, pattern, length, obliquity, angulation, translation and shortening. Postoperative radiographs were reviewed to determine shortening and angulation. Results There were 58 patients with 60 femoral shaft fractures stabilized with titanium nails, with 46 healing within acceptable parameters and 14 considered malunions. Six of the 14 malunions developed complications requiring early unplanned intervention. No patients in the treatment success group had a complication. Between the treatment success and failure groups, fracture pattern, location, length, obliquity, angulation, translation or shortening were not statistically different. Mean nail canal fill was significantly lower in the failure group (0.72 versus 0.81; p = 0.0146), with a receiver operating characteristic curve identifying canal fill 76% as the optimal threshold. Conclusion This is the first study to measure the length and obliquity of paediatric femoral shaft fractures and to determine their relationship to radiographic alignment after healing. None of the preoperative fracture characteristics were predictive of malalignment or shortening. We recommend the use of larger nail sizes in the treatment of paediatric femoral shaft fractures, especially if there is concern for residual instability. Level of evidence IV

Social and Economic Benefits of Flexible Intramedullary Nails in the Treatment of Pediatric Femoral Shaft Fractures

Orthopedics ◽  
2002 ◽  
Vol 25 (10) ◽  
pp. 1067-1070
Author(s):  
Justin Greisberg ◽  
Mary J Bliss ◽  
Craig P Eberson ◽  
Patricia Solga ◽  
Charles d'Amato
Keyword(s):  
Femoral Shaft ◽  
Economic Benefits ◽  
Intramedullary Nails ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Flexible Intramedullary Nails

scholarly journals Femoral shaft fractures in children with non-ambulatory neuromuscular disorders can be effectively treated using flexible intramedullary nails

2020 ◽  
Vol 14 (2) ◽  
pp. 132-138 ◽  
Author(s):  
Ali A. Siddiqui ◽  
Kenneth D. Illingworth ◽  
Oussama A. Abousamra ◽  
Erin M. Meisel ◽  
Robert M. Kay
Keyword(s):  
Neuromuscular Disorders ◽  
Femoral Shaft ◽  
Control Group ◽  
Angular Deformity ◽  
Intramedullary Nails ◽  
Femoral Shaft Fractures ◽  
Femur Fractures ◽  
Shaft Fractures ◽  
Fractures In Children ◽  
Flexible Intramedullary Nails

Purpose There is little information in the literature regarding flexible intramedullary nails (FIN) for treating femur fractures in children with neuromuscular disorders. The purpose of this study is to investigate the outcomes of FIN for femoral shaft fractures in non-ambulatory children with neuromuscular disorders. Methods A retrospective review was conducted on patients with femur fractures at a paediatric hospital between 2004 and 2018. Inclusion criteria were femoral shaft fracture treated with FIN. Outcomes were compared between patients with neuromuscular disorders (NM group) and a control group of those without neuromuscular disorders. Results A total of 37 patients with 37 femoral shaft fractures were studied (12 patients in the NM group and 25 in the control group). All NM group patients were non-ambulatory at baseline. Fractures were length stable in all 25 patients in the control group and in 2/12 (17%) patients in the NM group. All fractures healed in both groups. Three complications (all nail migrations) requiring reoperation before fracture union occurred in the NM group, yielding a major complication rate of 25% (3/12) in the NM group versus 0% (0/25) in controls (p = 0.03). Angular deformity occurred in 5/12 (42%) NM group patients and 1/25 (4%) control group patient (p = 0.009); none required reoperation. Conclusion Femur fractures in non-ambulatory children with neuromuscular disorders can be successfully treated with FIN. Angular deformities are common in this population, but had no functional impact in the non-ambulatory NM group patients. Surgeons must also be vigilant for implant prominence and skin breakdown in these patients. Level of evidence III

scholarly journals Flexible intramedullary nails: the panacea for paediatric femoral shaft fractures

2017 ◽  
Vol 3 (3) ◽  
pp. 411
Author(s):  
Jagdeep Singh ◽  
Jagandeep S. Virk ◽  
Anoop Kalia ◽  
Naveen Mittal
Keyword(s):  
Stainless Steel ◽  
Full Range ◽  
Femoral Shaft ◽  
Grey Zone ◽  
Age Group ◽  
Intramedullary Nails ◽  
Femoral Shaft Fractures ◽  
Femur Fractures ◽  
Shaft Fractures ◽  
Flexible Intramedullary Nails

<p class="abstract"><strong>Background:</strong> Management of pediatric femoral shaft fractures continues to evolve with time with flexible intramedullary nailing being one of the options to treat a specific age group of children. Grey zone exists concerning the cost effectiveness and appropriate timing of nail removal in treating such fractures. The objective of the study was<strong> </strong>to evaluate the treatment outcome of fracture shaft of the femur in children in the age group of 5- 12 years with flexible intramedullary nail<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> The study comprised of 30 consecutive cases of acute fractures of the femoral shaft in children of the age group of 5 to 12 years. Only closed fractures of the mid-diaphyseal region of the femur were included while supracondylar, subtrochanteric and pathological fractures were excluded. Flexible intramedullary nails of stainless steel (n=24) or titanium (n=6) were used for fixation of these fractures.<strong></strong></p><p class="abstract"><strong>Results:</strong> Evaluation of the results was done according to the criteria by Flynn et al. 21(70%) out of 30 patients had an excellent result and remaining 9 (30%) had a satisfactory result. All fractures united with a full range of motion at the hip and knee joint without any major complications<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Intramedullary elastic nailing of simple diaphyseal femur fractures in children is an effective method with negligible complications. Treatment cost can be significantly lowered by using the much cheaper stainless steel flexible nails rather than the more expensive titanium nails.</span></p>

scholarly journals THE MISSING LINK IN THE HISTORY OF THE LOCKED INTRAMEDULLARY NAIL

2021 ◽  
Vol 29 (4) ◽  
pp. 228-231
Author(s):  
FLÁVIO PIRES DE CAMARGO ◽  
GUILHERME PELOSINI GAIARSA ◽  
OLAVO PIRES DE CAMARGO ◽  
PAULO ROBERTO DOS REIS ◽  
JORGE DOS SANTOS SILVA ◽  
...  
Keyword(s):  
Standard Treatment ◽  
Femoral Shaft ◽  
Reference Level ◽  
Intramedullary Nails ◽  
Level Of Evidence ◽  
Femoral Shaft Fractures ◽  
Interlocking Nail ◽  
Major Development ◽  
The World ◽  
History Of

ABSTRACT Femoral Shaft intramedullary nails were first described by the Aztecs in 16th century, but the modern use of intramedullary nails as the gold standard treatment for femoral shaft fractures began with Gerald Kuntcher in 1939. From the first Kuntcher’s study in 1939, to the creation of interlocking nail, a long and some minor developments were described around the world. However, a major development is missing: the first nail to have a rotational and vertical stability locking system was described by Flavio Godoy Moreira, but was never published on an indexed journal for the correct historical reference. Level of Evidence V, Therapeutics Studies, Expert Opinion.

Failure of Exchange Reamed Intramedullary Nails for Ununited Femoral Shaft Fractures

2000 ◽  
Vol 14 (5) ◽  
pp. 335-338 ◽  
Author(s):  
Matthew J. Weresh ◽  
Robyn Hakanson ◽  
Michael D. Stover ◽  
Stephen H. Sims ◽  
James F. Kellam ◽  
...  
Keyword(s):  
Femoral Shaft ◽  
Intramedullary Nails ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures

Femoral-shaft fractures and nonunions treated with intramedullary nails: The role of dynamisation

Injury ◽  
2011 ◽  
Vol 42 (11) ◽  
pp. 1353-1361 ◽  
Author(s):  
Costas Papakostidis ◽  
Ioannis Psyllakis ◽  
Demetrios Vardakas ◽  
Anastasios Grestas ◽  
Peter V. Giannoudis
Keyword(s):  
Femoral Shaft ◽  
Intramedullary Nails ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures

scholarly journals Role of Open Cerclage Wires Used in Patients with Comminuted Fractures of Femoral Shaft Treated with Intramedullary Nails

2020 ◽  
Author(s):  
Tzu-Hao Wang ◽  
Hao-Chun Chuang ◽  
Fa-Chuan Kuan ◽  
Chih-Kai Hong ◽  
Ming-Long Yeh ◽  
...  
Keyword(s):  
Femoral Shaft Fracture ◽  
Femoral Shaft ◽  
Shaft Fracture ◽  
Fracture Treatment ◽  
Union Rate ◽  
Intramedullary Nails ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Significant Difference ◽  
Cerclage Wiring

Abstract IntroductionThe role of open cerclage wiring in comminuted femoral shaft fracture treatment with intramedullary nails remains unclear. Here, we analyzed the effect of open cerclage wiring and the risk factors for nonunion after interlocking nailing in comminuted femoral shaft fracture treatment. We hypothesize that open cerclage wiring is applicable to patients with severe comminuted femoral shaft fractures without affecting bone healing.Patients and MethodsThis retrospective cohort study used data of consecutive patients who underwent interlocking nail fixation of a comminuted femoral shaft fracture between January 1, 2009, and December 31, 2016. First, eligible patients were divided into wire and no wire groups according to the surgical technique used and their union rate was recorded. The patients were then divided into union and nonunion groups and their perioperative data were analyzed.ResultsIn total, 71 comminuted femoral shaft fractures treated with interlocking nail fixation were included: 38 fractures (53.5%) augmented with the open wiring technique and 33 reduced with closed or mini–open wound without wiring. The wire group demonstrated significant improvements in fracture reduction compared with the no wire group, whereas no significant difference was observed in the union rate between the wire and no wire groups (p = 0.180). Moreover, 46 (65%) of 71 fractures united smoothly, and no significant difference was observed in any perioperative data between union and nonunion groups.DiscussionAugmented open cerclage wiring is indicated for comminuted femoral shaft fractures treated with intramedullary nails, even when the fragments are large or far displaced. Thus, open cerclage wiring can be used for fracture treatment, without decreasing the union rate.

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