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Titanium Elastic Nailing with Temporary External Fixator versus Bridge Plating in Comminuted Pediatric Femoral Shaft Fractures: A Comparative Study

  • Symposium - Pediatric Trauma
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

High-velocity trauma, associated injuries, risk of iatrogenic devascularization of fragments and need for maintaining alignment upto union make comminuted fracture in pediatric femur a formidable fracture to treat. This comparative study was conducted to evaluate the outcomes of two modes of management in such cases: titanium elastic nailing supplemented with external fixator and submuscular bridge plating (BP).

Materials and Methods

Thirty eight children (aged 6–12 years) with comminuted fracture shaft femur who were randomized into two groups underwent systematic evaluation. One group was operated with titanium nailing with temporary external stabilization by fixators (titanium nailing with external [TNE] group) for 4 weeks. The other underwent submuscular BP with locked plates (BP group). Clinical and radiological outcomes, operative time, blood loss, radiation exposure, difficulties in removal and complications were evaluated.

Results

Both groups achieved union (10.7 ± 1.9 weeks BP, 11 ± 1.6 weeks TNE), satisfactory knee flexion (138.2 ± 6.4° BP, 136 ± 7.3° TNE), and painless weight bearing (7.3 ± 0.9 weeks vs. 7.3 ± 1.4 weeks) in acceptable alignment. Functional outcomes were excellent in majority of both BP (15 of 19) and nail external fixator groups (15 of 18). Operating time and radiation exposure (69.5 ± 14.5 s vs. 50.9 ± 12.9 s) were more in TNE than in BP (P < 0.01). However, implant removal was more difficult in BP (56.4 ± 12.4 min in BP vs. 30.1 ± 8.8 min TNE). Pin-tract infections (n = 3) and hardware prominence (n = 2) in TNE group and deep infections (n = 2) in BP group were notable complications.

Conclusion

Two groups were similar in radiological and functional outcomes. Inserting elastic nails and external fixator was a more exacting surgery, while removal was more difficult in BP group. Both techniques had acceptable success and complication rates.

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Authors and Affiliations

  1. Institute of Paediatric Orthopaedic Disorders, Mumbai, Maharashtra, India

    Tarai Vishanji Nagda, Jaideep Dhamele & Chasanal Rathod

  2. Department of Physical Medicine and Rehabilitation, College of Physiotherapy and Medical Sciences, Guwahati, Assam, India

    Dipa Dey

  3. Department of Orthopaedics, Gauhati Medical College and Hospital, Guwahati, Assam, India

    Sukalyan Dey & Kartikey Mishra

Authors
  1. Sukalyan Dey
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  2. Kartikey Mishra
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  3. Tarai Vishanji Nagda
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  4. Jaideep Dhamele
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  5. Chasanal Rathod
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  6. Dipa Dey
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Correspondence to Sukalyan Dey.

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Dey, S., Mishra, K., Nagda, T.V. et al. Titanium Elastic Nailing with Temporary External Fixator versus Bridge Plating in Comminuted Pediatric Femoral Shaft Fractures: A Comparative Study. IJOO 52, 507–512 (2018). https://doi.org/10.4103/ortho.IJOrtho_304_17

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  • DOI: https://doi.org/10.4103/ortho.IJOrtho_304_17

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