Skip to main content

Advertisement

SpringerLink
Log in

An Observational Cohort Study of the Adoption of Elastic Stable Intramedullary Nailing for the Treatment of Pediatric Femur Fractures in Kumasi, Ghana

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

In high- and middle-income countries, elastic stable intramedullary nailing (ESIN) is the commonest treatment of femur fractures in children 5–11 years of age. At Komfo Anokye Teaching hospital (KATH) in Kumasi, Ghana, prior to this study all pediatric femur fractures were treated with skin traction to union. This study was designed to report the early results and costs of the adoption of ESIN at KATH to provide data to other low- and middle-income sites considering adoption of this surgical technique.

Methods

An observational cohort study that included 84 pediatric patients ages 3–14 years presenting with closed femur fractures and treated with either skin traction or ESIN. Multivariate logistic regression was used to compare the rate of treatment success between treatment groups.

Results

Treatment success (coronal and sagittal angulation less than 10 ° and shortening less than 15 mm at osseous union) was achieved in 92 % of the ESIN group versus 67 % of the skin traction group (odds ratio for ESIN group 9.28 (1.6–54.7); p = 0.0138). Average length of stay was significantly lower in the ESIN group (p = 0.001), but charges to patients were higher in the ESIN group (p < 0.001) because of the high cost of implants.

Conclusions

The initial experience of operative treatment of femoral shaft fractures in children using ESIN was positive, with improved rates of treatment success and no surgical complications. Because of the high cost of implants, direct costs of treatment remained higher with ESIN despite reductions in length of hospital stay.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Peden MM (2008) World report on child injury prevention. World Health Organization, xvii, Geneva, p 211

    Google Scholar 

  2. Yaffee AQ, Whiteside LK, Oteng RA et al (2012) Bypassing proximal health care facilities for acute care: a survey of patients in a Ghanaian accident and emergency centre. Trop Med Int Health 17:775–781

    Article  PubMed  CAS  Google Scholar 

  3. Rewers A, Hedegaard H, Lezotte D et al (2005) Childhood femur fractures, associated injuries, and sociodemographic risk factors: a population-based study. Pediatrics 115:e543–e552

    Article  PubMed  Google Scholar 

  4. Grimes CE, Bowman KG, Dodgion CM et al (2011) Systematic review of barriers to surgical care in low-income and middle-income countries. World J Surg 35:941–950. doi:10.1007/s00268-011-1010-1

    Article  PubMed  Google Scholar 

  5. Hedin H, Borgquist L, Larsson S (2004) A cost analysis of three methods of treating femoral shaft fractures in children. A comparison of traction in hospital, traction in hospital/home and external fixation. Acta Orthop 75:241–248

    Article  Google Scholar 

  6. Gaid M, Jeer P (2006) Cost analysis of managing paediatric femoral shaft fractures: flexible intramedullary nailing versus non-operative management. Acta Orthop Belg 72:170

    PubMed  Google Scholar 

  7. Clinkscales CM, Peterson HA (1997) Isolated closed diaphyseal fractures of the femur in children: comparison of effectiveness and cost of several treatment methods. Orthopedics 20:1131–1136

    PubMed  CAS  Google Scholar 

  8. Stans AA, Morrissy RT, Renwick SE (1999) Femoral shaft fracture treatment in patients age 6 to 16 years. J Pediatr Orthop 19:222–228

    Article  PubMed  CAS  Google Scholar 

  9. Subasi M, Kapukaya A (2006) Treatment options in pediatric femoral shaft fractures. J Orthop Trauma 20:297 (letter); author reply 297; author reply 298

  10. Flynn JM, Luedtke LM, Ganley TJ et al (2004) Comparison of titanium elastic nails with traction and a spica cast to treat femoral fractures in children. J Bone Jt Surg Am 86-A:770–777

    Google Scholar 

  11. Coyte PC, Bronskill SE, Hirji ZZ et al (1997) Economic evaluation of 2 treatments for pediatric femoral shaft fractures. Clin Orthop Relat Res 336:205–215

    Article  PubMed  Google Scholar 

  12. Kocher MS, Sink EL, Blasier RD et al (2010) American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of pediatric diaphyseal femur fracture. J Bone Jt Surg Am 92:1790–1792

    Article  Google Scholar 

  13. Wright JG, Wang EE, Owen JL et al (2005) Treatments for paediatric femoral fractures: a randomised trial. Lancet 365:1153–1158

    Article  PubMed  Google Scholar 

  14. Flynn JM, Schwend RM (2004) Management of pediatric femoral shaft fractures. J Am Acad Orthop Surg 12:347–359

    PubMed  Google Scholar 

  15. Mani US, Sabatino CT, Sabharwal S et al (2006) Biomechanical comparison of flexible stainless steel and titanium nails with external fixation using a femur fracture model. J Pediatr Orthop 26:182–187

    Article  PubMed  Google Scholar 

  16. Battle J, Carmichael KD, Morris RP (2006) Biomechanical comparison of flexible intramedullary nailing versus crossed Kirschner wire fixation in a canine model of pediatric forearm fractures. J Pediatr Orthop B 15:370–375

    Article  PubMed  Google Scholar 

  17. Green JK, Werner FW, Dhawan R et al (2005) A biomechanical study on flexible intramedullary nails used to treat pediatric femoral fractures. J Orthop Res 23:1315–1320

    Article  PubMed  Google Scholar 

  18. Ho CA, Skaggs DL, Tang CW et al (2006) Use of flexible intramedullary nails in pediatric femur fractures. J Pediatr Orthop 26:497–504

    Article  PubMed  Google Scholar 

  19. Johnson CW, Carmichael KD, Morris RP et al (2009) Biomechanical study of flexible intramedullary nails. J Pediatr Orthop 29:44–48

    Article  PubMed  Google Scholar 

  20. Shemshaki HR, Mousavi H, Salehi G et al (2011) Titanium elastic nailing versus hip spica cast in treatment of femoral–shaft fractures in children. J Orthop Traumatol 12:45–48

    Article  PubMed  PubMed Central  Google Scholar 

  21. Flynn JM, Luedtke L, Ganley TJ et al (2002) Titanium elastic nails for pediatric femur fractures: lessons from the learning curve. Am J Orthop (Belle Mead NJ) 31:71–74

    Google Scholar 

  22. Lascombes P, Haumont T, Journeau P (2006) Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop 26:827–834

    Article  PubMed  Google Scholar 

  23. Buck G (2007) An improved method of treating fractures of the thigh: illustrated by cases and a drawing. 1857. Clin Orthop Relat Res 458:52–58

    Article  PubMed  Google Scholar 

  24. Li Y, Heyworth BE, Glotzbecker M et al (2013) Comparison of titanium elastic nail and plate fixation of pediatric subtrochanteric femur fractures. J Pediatr Orthop 33:232–238

    Article  PubMed  CAS  Google Scholar 

  25. Flynn JM, Hresko T, Reynolds RA et al (2001) Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications. J Pediatr Orthop 21:4–8

    Article  PubMed  CAS  Google Scholar 

  26. Kasser JR, Beaty JH (2001) Femoral shaft fractures. In: Beaty JH, Kasser JR (eds) Rockwood and Wilkins’ fractures in children. Lippincott Williams and Wilkins, Philadelphia, p 948

    Google Scholar 

  27. Poolman RW, Kocher MS, Bhandari M (2006) Pediatric femoral fractures: a systematic review of 2422 cases. J Orthop Trauma 20:648–654

    PubMed  Google Scholar 

  28. Buechsenschuetz KE, Mehlman CT, Shaw KJ et al (2002) Femoral shaft fractures in children: traction and casting versus elastic stable intramedullary nailing. J Trauma 53:914–921

    Article  PubMed  Google Scholar 

  29. Herndon WA, Mahnken RF, Yngve DA et al (1989) Management of femoral shaft fractures in the adolescent. J Pediatr Orthop 9:29–32

    Article  PubMed  CAS  Google Scholar 

  30. Kirby RM, Winquist RA, Hansen STJ (1981) Femoral shaft fractures in adolescents: a comparison between traction plus cast treatment and closed intramedullary nailing. J Pediatr Orthop 1:193–197

    Article  PubMed  CAS  Google Scholar 

  31. Song HR, Oh CW, Shin HD et al (2004) Treatment of femoral shaft fractures in young children: comparison between conservative treatment and retrograde flexible nailing. J Pediatr Orthop B 13:275–280

    Article  PubMed  Google Scholar 

  32. 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

    Article  PubMed  Google Scholar 

  33. Bandyopadhyay R, Mukherjee A (2013) Short term complications of titanium elastic nail in the treatment of diaphyseal fracture of the femur in children. Open Orthop J 7:12–17

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hinton RY, Lincoln A, Crockett MM et al (1999) Fractures of the femoral shaft in children. Incidence, mechanisms, and sociodemographic risk factors. J Bone Jt Surg Am 81:500–509

    CAS  Google Scholar 

  35. Spiegel DA, Gosselin RA, Coughlin RR et al (2008) The burden of musculoskeletal injury in low and middle-income countries: challenges and opportunities. J Bone Jt Surg Am 90:915–923

    Article  Google Scholar 

  36. Debas HT, Gosselin R, McCord C, et al (2006) Surgery. In Jamison DT, Breman JG, Measham AR, et al (eds) Disease control priorities in developing countries, 2nd edn, p 1245

  37. Wilson NC, Stott NS (2007) Paediatric femoral fractures: factors influencing length of stay and readmission rate. Injury 38:931–936

    Article  PubMed  Google Scholar 

  38. Ramseier LE, Janicki JA, Weir S et al (2010) Femoral fractures in adolescents: a comparison of four methods of fixation. J Bone Jt Surg Am 92:1122–1129

    Article  Google Scholar 

  39. Rios AU, Arango DF, Molina CO et al (2009) Femoral shaft fractures treated with stainless steel flexible nails in children aged between 5 and 12 years at the HUSVP: a two-year follow-up. J Child Orthop 3:129–135

    Article  PubMed  PubMed Central  Google Scholar 

  40. World Health Organisation (W.H.O.) (2005) Choosing Interventions that are Cost Effective (WHO-CHOICE)

  41. Sturdee SW, Templeton PA, Dahabreh Z et al (2007) Femoral fractures in children; is early interventional treatment beneficial? Injury 38:937–944

    Article  PubMed  CAS  Google Scholar 

  42. Park SS, Noh H, Kam M (2013) Risk factors for overgrowth after flexible intramedullary nailing for fractures of the femoral shaft in children. Bone Jt J 95:254–258

    Article  Google Scholar 

Download references

Conflict of interest

All authors declare no external funding or conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA

    Scott P. Kaiser, Tai Holland & Richard C. Coughlin

  2. Department of Trauma and Orthopaedics, Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana

    Paa Kwesi Baidoo, Peter Konadu, Dominic Awariyah & Raphael A. Kumah-Ametepey

Authors
  1. Scott P. Kaiser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tai Holland
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paa Kwesi Baidoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Richard C. Coughlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter Konadu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dominic Awariyah
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Raphael A. Kumah-Ametepey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Scott P. Kaiser.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kaiser, S.P., Holland, T., Baidoo, P.K. et al. An Observational Cohort Study of the Adoption of Elastic Stable Intramedullary Nailing for the Treatment of Pediatric Femur Fractures in Kumasi, Ghana. World J Surg 38, 2818–2824 (2014). https://doi.org/10.1007/s00268-014-2664-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-014-2664-2

Keywords

Search

Navigation