Determine the Mean Duration of Union in Femoral Shaft Fracture in Children Treated with Elastic Intra-Medullary Nailing

Objective: The aim of this study is to determine the functional outcomes and mean duration of union in femoral shaft fracture in children treated with elastic intra-medullary nailing. Study Design:Retrospective Place and Duration: Conducted at Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and District Headquarter Teaching Hospital Gomal Medical College Dera Ismail Khan for duration from May 2020 to January 2021 (09 months). Methods: Total sixty eight patients with age ranges between 5-12 years were presented in this study. Patients detailed demographics age, sex and BMI were calculated after taking informed written consent. Complete patients were treated with elastic intramedullary nailing. Radiological assessment was done. Mean union time and complications associated to procedure were examined. Functional outcomes were analyzed according to the Flyn’s criteria. Follow-up was taken at 8 months postoperatively. Complete data was analyzed by SPSS 22.0 version. Results: Out of 68 patients, there were 48 (68.6%) males and 20 (31.4%) females. Most of the patients 41 (60.35) were aged between 8-12 years and the rest 27 (39.65%) were between 5-8 years.34 (50%) fractures were caused because of road accidents, falling from height were 20 (29.41%), due to sports were 10 (14.70%) and 4 (5.9%) were due to simple fall. 32 (47.06%) patients had left side fracture and 36 (52.94%) had right side fracture. Mean union time among patients was 4.14±2.72 months and there was no any case of non union. According to Flyn’s criteria, 50 (73.53%) cases had excellent results, 14 (20.6%) patients had good and fair results were among 4 (5.9%) cases. Complications were observed bone stiffness, delayed union and varus deformity among all cases. Conclusion: We concluded in this study thatElastic intramedullary nailing for femoral shaft fractures in children is safe and effective treatment modality. Union of bone achieved all the patients and majority of patients had excellent functional outcomes. Keywords: Femoral shaft fractures, Children, Elastic intra-medullary nail

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Outcome of Titanium Elastic Nailing in the Surgical Management of Femoral-Shaft Fracture in Children

Journal of KIST Medical College ◽

10.3126/jkistmc.v2i2.33755 ◽

2020 ◽

Vol 2 (2) ◽

pp. 61-66

Author(s):

Rajram Maharjan ◽

Rishi Bisht ◽

Dipesh Pariyar

Keyword(s):

Femoral Shaft Fracture ◽

Insertion Site ◽

Operating Time ◽

Femoral Shaft ◽

Shaft Fracture ◽

Age Group ◽

Femoral Shaft Fractures ◽

Titanium Elastic Nailing ◽

Shaft Fractures ◽

Fractures In Children

Introduction: Femoral shaft fracture is one of the most common orthopedic injuries of the children. These fractures treated non-operatively by traction followed by hip spica require prolonged hospitalization causing undue physical and psychological stress for patient and patient family. Loss of reduction is also commonly seen with hip spica that leads to unacceptable complications like angular deformities and limb length discrepancies. Titanium Elastic Nailing (TEN) is becoming widely accepted treatment for femoral shaft fractures in children due to its simplicity and physeal protective stable load sharing construct that allows early mobilization. The purpose of this study was to see the outcome of operative treatment of femoral shaft fracture in children by TEN. Methods: A retrospective observational study was carried out in the Department of Orthopedics in National Academy of Medical Sciences, National Trauma Center from February 2017 to January 2019. Study was undertaken in 22 children between the age group of 5-14 years with femoral shaft fractures. Fixation with TEN was done for all fractures within nine days of injury. Patients were assessed radiologically as well as clinically until fractures healed. The results were evaluated using Flynn scoring criteria. Results: Radiological union was seen in all cases between 6–12 weeks after surgery. The mean operating time was 58 (48-115) minute and mean hospital stay after surgery was 9 (6-15) days. Results were excellent in 14 patients (63.63%), satisfactory in 6 patients (27.37%) & poor in 2 patients (9%). Six patients had skin irritation at nail insertion site which resolved after removal of nails. Functional range of motion in both hip and knee joints of affected limb was preserved in all cases after the removal of nails. Conclusion: TEN is an effective and safe treatment of femoral shaft fractures in children of 5-14 years of age group.

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Comment to the publication of P. P. Schmittenbecher, H.-G. Dietz: Elastic stable intramedullary nailing of femoral shaft fractures in children (“Nancy-nailing”)

Orthopaedics and Traumatology ◽

10.1007/bf02620783 ◽

1995 ◽

Vol 4 (4) ◽

pp. 210-211

Author(s):

Lutz Laer

Keyword(s):

Intramedullary Nailing ◽

Femoral Shaft ◽

Elastic Stable Intramedullary Nailing ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Fractures In Children

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

10.21203/rs.3.rs-49503/v1 ◽

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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Outcome of Titanium Elastic Intramedullary Nail in the Treatment of Shaft of Femur Fracture in Children

Kathmandu University Medical Journal ◽

10.3126/kumj.v13i3.16799 ◽

2017 ◽

Vol 13 (3) ◽

pp. 195-199

Author(s):

J.A. Khan ◽

G.P. Singh ◽

A. Pandey

Keyword(s):

Range Of Motion ◽

Intramedullary Nailing ◽

Femoral Shaft ◽

Limb Length Discrepancy ◽

Elastic Stable Intramedullary Nailing ◽

Limb Length ◽

Femoral Shaft Fractures ◽

Length Discrepancy ◽

Shaft Fractures ◽

Fractures In Children

Background Femoral-shaft fractures are among the most common fractures of the lower extremity in children. There are several different options for treating femoral-shaft fractures in children. Elastic stable intramedullary nailing (ESIN) has become the standard treatment for fractures of shaft of femur in children for reasons including mini-invasive surgery, no need for casting, early mobilization and discharge as well as growing concerns toward cost-effectiveness.Objective To demonstrate the effectiveness of intramedullary fixation of fracture shaft of femur in skeletally immature children using the titanium elastic intramedullary nails.Method Forty children who underwent fixation with titanium intramedullary nails because of fracture of shaft of femur (Winquist and Hansen type 1 and 2) were reviewed. There were 60% male and 40% female patients and mean follow-up was six months. Time of union, deformity at fracture site, limb length discrepancy, knee range of motion and complications were assessed.Result Average age of the patients was 5.17 years (range 3 to 10). All patients achieved complete healing at a mean 12.8 weeks (range 10 to 20 weeks). Average limb length discrepancy was -0.16 cm (range -1.0 to 1.1 cm) average knee range of motion was 137.55 degrees (range 118 to 152 degrees). Complications were recorded in 13 (31.7%) patients and included: Five malunion which did not show any deformity or functional impairment and eight superficial wound infections which were healed after removal of nail. All patients were active as their pre injury levels at six months follow up.Conclusion Elastic stable intramedullary nailing is the method of choice for the simple pediatrics fracture shaft of femur, as it is minimally invasive and shows good functional and cosmetic results. It allows short hospital stay and quick recovery from pain and is cast-free.

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Poor prognostic factors of femoral shaft fractures in children treated by elastic intramedullary nailing

SICOT-J ◽

10.1051/sicotj/2020031 ◽

2020 ◽

Vol 6 ◽

pp. 34

Author(s):

Alexandru Ulici ◽

Elena Odagiu ◽

Oana Haram ◽

Adelina Ionescu ◽

Gabriel Alin Sterian ◽

...

Keyword(s):

Postoperative Complications ◽

Intramedullary Nailing ◽

Femoral Shaft ◽

Delayed Union ◽

Elastic Stable Intramedullary Nailing ◽

Mechanism Of Injury ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Fractures In Children ◽

Elastic Intramedullary Nailing

Introduction: Femoral shaft fractures in pediatric patients are treated by elastic intramedullary nailing using titanium or stainless-steel nails. The elastic stable intramedullary nailing behaves as an internal splint, promoting early mobilization. This type of treatment involves a minimally invasive approach, no damage to the growth plates, and no impairment of femoral head blood supply. Purpose: The aim of our study was to identify the negative predicting factors that might lead to an increased complication rate after elastic stable intramedullary nailing of femoral shaft fractures in children. Methods: We conducted a retrospective study on 137 patients with femoral shaft fractures treated by elastic stable intramedullary nailing. Patients’ age ranged between 4 and 17 years. We used data from the medical records of the patients to evaluate postoperative complications. Plain radiographs were analyzed to determine the fracture type, fracture location, and postoperative complications such as delayed union, angular deformities, and limb length discrepancies. Multivariate analysis was conducted to identify predictors for poor outcomes. Results: Complications occurred in 29 patients (21%) and consisted of delayed union, axial deformities, or lower limb length discrepancies. In the group of patients that suffered from complications, mechanism of injury, age, and weight were significant. They were older by an average of 5 years; half of them weighed more than 50 kg and over a half were involved in a road traffic accident. Conclusions: Elastic nailing is a successful tool to treat femoral shaft fractures. Three factors were demonstrated to influence the outcome. The mechanism of injury, age > 11 years, and weight > 50 kg are the most important and are predictors for development of complications such as delayed union or deformity.

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