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Intramedullary nails for pediatric diaphyseal femur fractures in older, heavier children: early results

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

Abstract

Purpose

A common treatment for pediatric femur fractures is intramedullary nail (IMN) insertion. Elastic stable intramedullary nails (ESINs) are often used for these procedures in heavier patients, but the potential for complications and malunion is greater. We describe here a rigid IMN specifically designed for adolescents, the adolescent lateral entry femoral nail (ALFN). The purpose of this study was to compare the recovery and complications for patients treated with ESINs to those treated with the ALFN.

Methods

Our study design was a retrospective cohort study. We performed a review of medical records of 22 children ages 10–17 requiring surgical fixation of a femur fracture for a 2½-year period. Patients selected for the study had traumatic diaphyseal femur fractures and were treated with ESINs without end-caps or ALFNs. Our analyses evaluated injury, surgical, and outcome information for all patients.

Results

Twenty-two patients were eligible for inclusion and were divided into two groups according to their treatment: the ESIN group with 7 patients and the ALFN group with 15 patients. We then performed a comparison of complications and recovery for these patients. The mean time to full weight-bearing was significantly less for the ALFN group (4.1 weeks; SD, 2.2), than the ESIN group (9.4 weeks; SD 3.9). There was no statistical difference in the incidence of major or minor complications.

Conclusions

Older, heavier pediatric patients treated for femur fracture with ALFNs had a shorter recovery time than similar patients treated with ESINs. However, the outcomes for both groups were satisfactory.

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References

  1. Kuremsky MA, Frick SL (2007) Advances in the surgical management of pediatric femoral shaft fractures. Curr Opin Pediatr 19:51–57

    Article  Google Scholar 

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

    Google Scholar 

  3. Kanlic E, Cruz M (2007) Current concepts in pediatric femur fracture treatment. Orthopedics 30:1015–1019

    Google Scholar 

  4. Hunter JB (2005) Femoral shaft fractures in children. Injury 36(Suppl 1):A86–A93

    Article  Google Scholar 

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

    Google Scholar 

  6. 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  Google Scholar 

  7. Wall EJ, Jain V, Vora V, Mehlman CT, Crawford AH (2008) Complications of titanium and stainless steel elastic nail fixation of pediatric femoral fractures. J Bone Joint Surg Am 90:1305–1313

    Article  Google Scholar 

  8. Li Y, Stabile KJ, Shilt JS (2008) Biomechanical analysis of titanium elastic nail fixation in a pediatric femur fracture model. J Pediatr Orthop 28:874–878

    Article  Google Scholar 

  9. Salem KH, Keppler P (2010) Limb geometry after elastic stable nailing for pediatric femoral fractures. J Bone Joint Surg Am 92:1409–1417

    Article  Google Scholar 

  10. Moroz LA, Launay F, Kocher MS, Newton PO, Frick SL, Sponseller PD, Flynn JM (2006) Titanium elastic nailing of fractures of the femur in children. Predictors of complications and poor outcome. J Bone Joint Surg Br 88:1361–1366

    Article  CAS  Google Scholar 

  11. Nectoux E, Giacomelli MC, Karger C, Gicquel P, Clavert JM (2008) Use of end caps in elastic stable intramedullary nailing of femoral and tibial unstable fractures in children: preliminary results in 11 fractures. J Child Orthop 2:309–314

    Article  CAS  Google Scholar 

  12. Slongo T, Audigè L, Hunter JB, Berger SM (2011) Clinical evaluation of end caps in elastic stable intramedullary nailing of femoral and tibial shaft fractures in children. Eur J Trauma Emerg Surg 37:305–312

    Article  Google Scholar 

  13. Ellis HB, Ho CA, Podwesza DA, Wilson PL (2011) A comparison of locked versus nonlocked enders rods for length unstable pediatric femoral shaft fractures. J Pediatr Orthop 31:825–833

    Article  Google Scholar 

  14. Schmittenbecher PP, Dietz HG, Linhart WE, Slongo T (2000) Complications and problems in intramedullary nailing of children’s fractures. Eur J Trauma 26:287–293

    Article  Google Scholar 

  15. 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

    Article  CAS  Google Scholar 

  16. Ricci WM, Devinney S, Haidukewych G, Herscovici D, Sanders R (2005) Trochanteric nail insertion for the treatment of femoral shaft fractures. J Orthop Trauma 19:511–517

    Article  Google Scholar 

  17. Starr AJ, Hay MT, Reinert CM, Borer DS, Christensen KC (2006) Cephalomedullary nails in the treatment of high-energy proximal femur fractures in young patients: a prospective, randomized comparison of trochanteric versus piriformis fossa entry portal. J Orthop Trauma 20:240–246

    Article  Google Scholar 

  18. Ricci WM, Schwappach J, Tucker M, Coupe K, Brandt A, Sanders R, Leighton R (2006) Trochanteric versus piriformis entry portal for the treatment of femoral shaft fractures. J Orthop Trauma 20:663–667

    Article  Google Scholar 

  19. Synthes, Inc (2009) Synthes technique guide for titanium cannulated adolescent femoral nail, copyright 2009. Synthes, Inc, Westchester, PA

    Google Scholar 

  20. MacNeil JA, Francis A, El-Hawary R (2011) A systematic review of rigid, locked, intramedullary nail insertion sites and avascular necrosis of the femoral head in the skeletally immature. J Pediatr Orthop 31:377–380

    Article  Google Scholar 

  21. Gordon JE, Khanna N, Luhmann SJ, Dobbs MB, Ortman MR, Schoenecker PL (2004) Intramedullary nailing of femoral fractures in children through the lateral aspect of the greater trochanter using a modified rigid humeral intramedullary nail: preliminary results of a new technique in 15 children. J Orthop Trauma 18:416–422

    Article  Google Scholar 

  22. Townsend DR, Hoffinger S (2000) Intramedullary nailing of femoral shaft fractures in children via the trochanter tip. Clin Orthop Relat Res 376:113–118

    Article  Google Scholar 

  23. Gregory P, Sullivan JA, Herndon WA (1995) Adolescent femoral shaft fractures: rigid versus flexible nails. Orthopedics 18:645–649

    CAS  Google Scholar 

  24. Linke B, Ansari Moein C, Bosl O, Verhofstad MH, van der Werken C, Schwieger K, Ito K (2008) Lateral insertion points in antegrade femoral nailing and their influence on femoral bone strains. J Orthop Trauma 22:716–722

    Article  Google Scholar 

  25. Ehmke LW, Polzin BM, Madey SM, Bottlang M (2006) Femoral nailing through the trochanter: the reamer pathway indicates a helical nail shape. J Orthop Trauma 20:668–674

    Article  Google Scholar 

  26. Kanellopoulos AD, Yiannakopoulos CK, Soucacos PN (2006) Closed, locked intramedullary nailing of pediatric femoral shaft fractures through the tip of the greater trochanter. J Trauma 60:217–222

    Article  Google Scholar 

  27. Keeler KA, Dart B, Luhmann SJ, Schoenecker PL, Ortman MR, Dobbs MB, Gordon JE (2009) Antegrade intramedullary nailing of pediatric femoral fractures using an interlocking pediatric femoral nail and a lateral trochanteric entry point. J Pediatr Orthop 29:345–351

    Article  Google Scholar 

  28. Anglen JO, Choi L (2005) Treatment options in pediatric femoral shaft fractures. J Orthop Trauma 19:724–733

    Article  Google Scholar 

  29. Holsalkar HS, Pandya NK, Cho RH, Glaser DA, Moor MA, Herman MJ (2011) Intramedullary nailing of pediatric femoral shaft fracture. J Am Acad Orthop Surg 19:472–481

    Google Scholar 

  30. Kocher MS, Sink EL, Blasier RD, Luhmann SJ, Mehlman CT, Scher DM et al (2010) American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of pediatric diaphyseal femur fracture. J Bone Joint Surg Am 92:1790–1792

    Article  Google Scholar 

  31. Audigé L, Slongo T, Kellam J, Agel J, Nebel A, Cornelius P, Sauter D, AO Foundation (2008) Comprehensive injury automatic classifier AO COIAC [computer program] version 3.0. AO Clinical Investigation and Documentation, Dübendorf

    Google Scholar 

  32. 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

    Article  Google Scholar 

  33. Rathjen KE, Riccio AI, De La Garza D (2007) Stainless steel flexible intramedullary fixation of unstable femoral shaft fractures in children. J Pediatr Orthop 27:432–441

    Article  Google Scholar 

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

    Article  Google Scholar 

  35. 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

    Article  CAS  Google Scholar 

  36. Jencikova-Celerin L, Phillips JH, Werk LN, Wiltrout SA, Nathanson I (2008) Flexible interlocked nailing of pediatric femoral fractures: experience with a new flexible interlocking intramedullary nail compared with other fixation procedures. J Pediatr Orthop 28:864–873

    Article  Google Scholar 

  37. Salem KH, Lindemann I, Keppler P (2006) Flexible intramedullary nailing in pediatric lower limb fractures. J Pediatr Orthop 26:505–509

    Article  Google Scholar 

  38. 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  Google Scholar 

  39. Aksoy MC, Caglar O, Ayvaz M, Yazici M, Alpaslan AM (2008) Treatment of complicated pediatric femoral fractures with titanium elastic nail. J Pediatr Orthop B 17:7–10

    Article  Google Scholar 

  40. Garner MR, Bhat SB, Khujanazarov I, Flynn JM, Spiegel D (2011) Fixation of length-stable femoral shaft fractures in heavier children: flexible nails vs rigid locked nails. J Pediatr Orthop 31:11–16

    Article  Google Scholar 

  41. Hedequist D, Bishop J, Hresko T (2008) Locking plate fixation for pediatric femur fractures. J Pediatr Orthop 28:6–9

    Article  Google Scholar 

  42. Sink EL, Faro F, Polousky J, Flynn K, Gralla J (2010) Decreased complications of pediatric femur fractures with a change in management. J Pediatr Orthop 30:633–637

    Article  Google Scholar 

  43. Sanders JO, Browne RH, Mooney JF, Raney EM, Horn BD, Anderson DJ, Hennrikus WL, Robertson WW (2001) Treatment of femoral fractures in children by pediatric orthopedists: results of a 1998 survey. J Pediatr Orthop 21:436–441

    CAS  Google Scholar 

  44. Russell TA, Mir HR, Stoneback J, Cohen J, Downs B (2008) Avoidance of malreduction of proximal femoral shaft fractures with the use of a minimally invasive nail insertion technique (MINIT). J Orthop Trauma 22:391–398

    Article  Google Scholar 

Download references

Acknowledgments

The authors would like to thank the AO Foundation for use of their fracture classification software program, AO COIAC Comprehensive Injury Automatic Classifier (AO Clinical Investigation and Documentation, Dübendorf, Switzerland, www.aofoundation.org/aocoiac). The authors would also like to thank Synthes, Inc., and its affiliates, for use of images from their technical manual.

Conflict of interest

None of the authors received financial or grant support for this study.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Children’s Hospital of Michigan, Detroit Medical Center, Detroit, MI, USA

    Richard A. K. Reynolds & Julie E. Legakis

  2. Department of Clinical Pharmacology, Children’s Hospital of Michigan, Detroit Medical Center, Detroit, MI, USA

    Ronald Thomas

  3. Department of Pediatric Surgery, University Children’s Hospital, Bern, Switzerland

    Theddy F. Slongo

  4. Queen’s Medical Centre, Nottingham University Hospital, Nottingham, UK

    James B. Hunter

  5. Centre Hospitalier Hautepierre, Service de Chirurgie Infantile, Strasbourg, France

    Jean-Michel Clavert

Authors
  1. Richard A. K. Reynolds
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  2. Julie E. Legakis
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  3. Ronald Thomas
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  4. Theddy F. Slongo
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  5. James B. Hunter
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  6. Jean-Michel Clavert
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Corresponding author

Correspondence to Julie E. Legakis.

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Reynolds, R.A.K., Legakis, J.E., Thomas, R. et al. Intramedullary nails for pediatric diaphyseal femur fractures in older, heavier children: early results. J Child Orthop 6, 181–188 (2012). https://doi.org/10.1007/s11832-012-0404-4

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  • DOI: https://doi.org/10.1007/s11832-012-0404-4

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