Abstract
Purpose
Titanium elastic nail (TEN) as an alternative to traction and spica cast in preschool children has not been widely studied for its safety and effectiveness.
Methods
A cohort of 59 children with 59 fractures (non-pathological; not involving condyles or cervicotrochanteric area) were retrospectively examined. Their mean age was 4.5 ± 0.9 years and their mean weight was 14.5 ± 3.7 kg. All but five were closed (21 transverse, 19 oblique and 19 spiral). Thirty-five were caused by motor vehicle accidents and 24 by falls. There were six upper third, 27 upper-middle junction, 14 middle third, seven lower-middle junction, and five lower third fractures.
Results
The mean follow-up was 41.8 ± 4.3 months, the mean hospital stay was 1.3 ± 0.87 days, and the mean time to nail removal was 20.3 ± 10.2 weeks. The mean time to union was 7.6 ± 1.5 weeks. Union was significantly correlated to age (p = 0.000) and fracture shape (p = 0.005), but not to the fracture level, nature, or mechanism. Shortening of ≥1.0 cm occurred in two cases (3.4 %), with an overall mean of 0.06 ± 0.21 cm. Shortening was significantly correlated to the fracture shape (p = 0.020), but not to the level. Overgrowth of ≥1 cm occurred in seven cases (11.9 %), with an overall mean of 0.22 ± 0.41 cm. Overgrowth was insignificantly correlated to the fracture level and shape. Frontal angulation of 5–9º occurred in six cases (10.2 %) and sagittal angulation of 3–7º occurred in seven cases (11.9 %). A rotational deformity of 10º occurred in two cases (3.4 %). Five cases had a painful nail end (8.5 %) and exteriorization with superficial infection occurred in two cases (3.4 %).
Conclusion
TEN is a dependable, safe, and cost-effective alternative to traction and cast in preschool children.
Similar content being viewed by others
References
Reinberg O, Frey P, Meyrat BJ (1994) Treatment of pediatric fractures by intramedullary stable elastic pinning. Z Unfallchir Versicherungsmed 87:110–118
Wright JG (2000) The treatment of femoral shaft fractures in children: a systematic overview and critical appraisal of the literature. Can J Surg 43:180–189
Bopst L, Reinberg O, Lutz N (2007) Femur fracture in preschool children: experience with flexible intramedullary nailing in 72 children. J Pediatr Orthop 27:299–303
Mortier D, De Ridder K (2008) Flexible intramedullary nailing in the treatment of diaphyseal fractures of the femur in preschool children. Acta Orthop Belg 74:190–194
Frech-Dörfler M, Hasler CC, Häcker FM (2010) Immediate hip spica for unstable femoral shaft fractures in preschool children: still an efficient and effective option. Eur J Pediatr Surg 20:18–23
d’Ollonne T, Rubio A, Leroux J, Lusakisimo S, Hayek T, Griffet J (2009) Early reduction versus skin traction in the orthopaedic treatment of femoral shaft fractures in children under 6 years old. J Child Orthop 3:209–215
Jauquier N, Doerfler M, Haecker FM, Hasler C, Zambelli PY, Lutz N (2010) 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 4:461–465
Allen BL Jr, Schoch EP 3rd, Emery FE (1978) Immediate spica cast system for femoral shaft fractures in infants and children. South Med J 71:18–22
Wainwright AM, Narayanan UG (2007) A new technique for reduction of paediatric femoral fractures using elastic stable intramedullary nails. Ann R Coll Surg Engl 89:432–434
Ali M, Raza A (2005) Union and complications after Thomas splint and early hip spica for femoral shaft fractures in children. J Coll Physicians Surg Pak 15:799–801
Kanlic EM, Anglen JO, Smith DG, Morgan SJ, Pesántez RF (2004) Advantages of submuscular bridge plating for complex pediatric femur fractures. Clin Orthop Relat Res 426:244–251
Cuddy CM (1986) Caring for the child in a spica cast: a parent’s perspective. Orthop Nurs 5:17–21
Braun W, Zerai H, Mayr E, Rüter A (1995) Pediatric femoral shaft fracture: effect of treatment procedure on results with reference to somatic and psychological aspects. Unfallchirurg 98:449–453
Wright JG, Wang EE, Owen JL, Stephens D, Graham HK, Hanlon M, Nattrass GR, Reynolds RA, Coyte P (2005) Treatments for paediatric femoral fractures: a randomised trial. Lancet 365:1153–1158
Large TM, Frick SL (2003) Compartment syndrome of the leg after treatment of a femoral fracture with an early sitting spica cast. A report of two cases. J Bone Joint Surg Am 85A:2207–2210
Metaizeau JP (2004) Stable elastic intramedullary nailing for fractures of the femur in children. J Bone Joint Surg Br 86:954–957
Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J (2001) Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications. J Pediatr Orthop 21:4–8
Hedequist D, Bishop J, Hresko T (2008) Locking plate fixation for pediatric femur fractures. J Pediatr Orthop 28:6–9
Domb BG, Sponseller PD, Ain M, Miller NH (2002) Comparison of dynamic versus static external fixation for pediatric femur fractures. J Pediatr Orthop 22:428–430
Mubarak SJ, Frick S, Sink E, Rathjen K, Noonan KJ (2006) Volkmann contracture and compartment syndromes after femur fractures in children treated with 90/90 spica casts. J Pediatr Orthop 26:567–572
Miner T, Carroll KL (2000) Outcomes of external fixation of pediatric femoral shaft fractures. J Pediatr Orthop 20:405–410
Pate O, Hedequist D, Leong N, Hresko T (2009) Implant removal after submuscular plating for pediatric femur fractures. J Pediatr Orthop 29:709–712
Prévot J, Lascombes P, Ligier JN (1993) The ECMES (Centro-Medullary Elastic Stabilising Wiring) osteosynthesis method in limb fractures in children. Principle, application on the femur. Apropos of 250 fractures followed-up since 1979. Chirurgie 119:473–476
Ramseier LE, Janicki JA, Weir S, Narayanan UG (2010) Femoral fractures in adolescents: a comparison of four methods of fixation. J Bone Joint Surg Am 92:1122–1129
Saseendar S, Menon J, Patro DK (2010) Treatment of femoral fractures in children: is titanium elastic nailing an improvement over hip spica casting? J Child Orthop 4:245–251
Sink EL, Gralla J, Repine M (2005) Complications of pediatric femur fractures treated with titanium elastic nails: a comparison of fracture types. J Pediatr Orthop 25:577–580
Conflict of interest
The authors did not receive any financial support or benefits from commercial sources for the work reported in this manuscript and do not have any other financial interests that could create a potential conflict of interest or the appearance of a conflict of interest with regard to this work.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Assaghir, Y.M. Titanium elastic nail in femur fractures as an alternative to spica cast in preschoolers. J Child Orthop 6, 505–511 (2012). https://doi.org/10.1007/s11832-012-0448-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11832-012-0448-5