A Comparison of Overgrowth after Treatment for Pediatric Femoral Shaft Fractures: Flexible Intramedullary Nailing versus External Fixation

BACKGROUND Femoral shaft fractures result from high energy trauma and maybe associated with life threatening conditions. Typical in younger people is associated with polytrauma. Though intramedullary nailing (IMN) is the gold standard option of treatment, external fixation (EF) can also be used temporarily or definitively, in such cases. The aim of this study was to compare the functional outcome of these two procedures. METHODS This prospective comparative study was conducted at our centre over a period of 6 years. Age, sex of the patients, laterality, type of fracture with mean follow up, union time, and complications such as delayed union, angular deformities, and limb length discrepancies were tabulated and compared. RESULTS There were more cases of open fractures in the EF group compared to IMN group. In the IMN group the average surgery duration was 95.76 minutes and it was 69.4 minutes in the EF group. The average time for bone union was 25.66 weeks in IMF group and 28.22 weeks in EF group. Complication rate was higher in EF group with 11 complications (7 major & 4 minor) compared to IMN group with only 6 cases presenting with complications (3 each of major & minor). CONCLUSIONS Though IMN is the gold standard in treatment of femoral shaft fractures, EF in polytrauma is an alternative method for definitive fracture stabilization, with minimal additional operative trauma and an acceptable complication rate. KEYWORDS Femoral Shaft Fractures, Intramedullary Nailing, External Fixation, Polytrauma, Definitive Treatment

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Immediate hip spica is as effective as, but more efficient than, flexible intramedullary nailing for femoral shaft fractures in pre-school children

Journal of Children s Orthopaedics ◽

10.1007/s11832-010-0279-1 ◽

2010 ◽

Vol 4 (5) ◽

pp. 461-465 ◽

Cited By ~ 17

Author(s):

Nicolas Jauquier ◽

Martina Doerfler ◽

Frank-Martin Haecker ◽

Carol Hasler ◽

Pierre-Yves Zambelli ◽

...

Keyword(s):

Intramedullary Nailing ◽

School Children ◽

Femoral Shaft ◽

Femoral Shaft Fractures ◽

Flexible Intramedullary Nailing ◽

Shaft Fractures

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Definitive Treatment of Femoral Shaft Fractures: Comparison between Anterograde Intramedullary Nailing and Monoaxial External Fixation

Journal of Clinical Medicine ◽

10.3390/jcm8081119 ◽

2019 ◽

Vol 8 (8) ◽

pp. 1119 ◽

Cited By ~ 2

Author(s):

Gianluca Testa ◽

Andrea Vescio ◽

Domenico Costantino Aloj ◽

Giacomo Papotto ◽

Luigi Ferrarotto ◽

...

Keyword(s):

External Fixation ◽

Intramedullary Nailing ◽

Gold Standard ◽

Femoral Shaft ◽

Bone Union ◽

Definitive Treatment ◽

Ao Classification ◽

Femoral Shaft Fractures ◽

Shaft Fractures

Background: Femoral shaft fractures result from high-energy trauma. Despite intramedullary nailing (IMN) representing the gold standard option of treatment, external fixation (EF) can be used temporarily for damage control or definitively. The purpose of this study is to compare two different options, anterograde IMN and monoaxial EF, for the treatment of femoral shaft fractures. Methods: Between January 2005 and December 2014, patients with femoral shaft fractures operated on in two centers were retrospectively evaluated and divided into two groups: the IMN group (n = 74), and the EF group (n = 73). For each group, sex; laterality; age; and AO classification type mean follow-up, mean union time, and complications were reported. Results: Both groups were found to have no statistical differences (p > 0.05) in sex, laterality, age, and AO classification types. In the IMN group the average surgery duration was 79.7 minutes (range 45–130). The average time for bone union was 26.9 weeks. Major complications occurred in 4 (5.4%) patients. In the EF group the average follow-up duration was 59.8 months (range 28–160). The average time for bone union was 24.0 weeks. Major complications occurred in 16 (21.9%) patients. Conclusions: IMN is the gold standard for definitive treatment of femoral shaft fractures. In patients with severe associated injuries, EF should be a good alternative.

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