L’inchiodamento endomidollare nell’infanzia

Abstract

Elastic stable intramedullary nailing has become a well-accepted method of osteosynthesis of diaphyseal fractures in children and adolescent. The reasons include rare necessity of a postoperative cast, primary bone union with avoidance of growth plate injuries and minimal invasive surgery.

Complications are mainly caused by technical mistakes, including too-thin nails, asymmetry of the frame and malorientations of implants. Non union was never observed in fractures of the femur and the forearm, osteomyelitis rate is about 2% and mean overgrowth of the femur is less than 10 mm before 10 years of age.

Indications are fractures of the diaphysis, all the fractures of the femur between 6 years of age and the end of growth, except for severe open grade III fractures, all of the instable forearm fractures and some instable fractures of the humerus and the tibia during adolescence or before the end of growth.

The technique is indicated also in polytraumatism and multiple-injured patients. The results are good when the indications are correct and the surgeon has a complete knowledge of the technique, especially in fracture reduction and stability.