Clinical and radiographic evaluation of femoral shaft fractures in a pediatric population treated with titanium elastic nails
Abstract
Aim: The main goal of study is to evaluate the clinical, functional and radiographic results of titanium elastic nail (TEN), which is among the most preferred methods in the treatment of pediatric femoral shaft fractures.
Materials and Methods: In this study, 33 patients, the ages of from 4 to14 years and weighing less than 50 kg, who were diagnosed with femoral shaft fractures between January 2018 and December 2019 and operated on with the TEN method in our clinic, were evaluated retrospectively. The demographic information of the patients, injury mechanism, fracture pattern, duration of surgery, radiographic union time, degree of residual deformity in the coronal and sagittal planes after union, nonunion rate, leg length discrepancy and postoperative weight-bearing times were examined.
Results: Femoral shaft fractures were seen 2.3 times more often in boys than in girls. Patients are often injured as a result of high-energy trauma such as traffic accidents and falls from a height. According to radiographic measurements, mean residual deformity of 3.23 ± 2.46 degrees in the coronal plane and 4.56 ± 3.78 degrees in the sagittal plane was measured and a mean discrepancy of 1.36 ± 0.85 cm was found between the two legs. Radiographic union time was calculated as 10.41 ± 3.55 weeks on average.
Conclusion: If applied with the right indication and the right technique, the TEN method is extremely important and successful in the treatment of femoral shaft fractures in pediatric patients younger than 15 years old and weighing less than 50 kg.
References
- Loder RT, O’Donnell PW, Feinberg JR. Epidemiology and mechanisms of femur fractures in children. J Pediatr Orthop 2006; 26 (5): 561–6.
- Loizou CL, McNamara I, Ahmed K, Pryor GA, Parker MJ. Classification of subtrochanteric femoral fractures. Injury 2010; 41 (7): 739–45.
- Jarvis J, Davidson D, Letts M. Management of subtrochanteric fractures in skeletally immature adolescents. J Trauma 2006; 60 (3): 613–9.
- Pombo MW, Shilt JS. The definition and treatment of pediatric subtrochanteric femur fractures with titanium elastic nails. J Pediatr Orthop 2006; 26 (3): 364–70.
- Ireland DC, Fisher RL. Subtrochanteric fractures of the femur in children. Clin Orthop Relat Res 1975; (110): 157–66.
- Catena N, Sénès FM, Riganti S, Boero S. Diaphyseal femoral fractures below the age of six years: results of plaster application and long term followup. Indian J Orthop 2014; 48 (1): 30–4.
- Flynn JM, Schwend RM, Flynn JM, Schwend RM. Management of pediatric femoral shaft fractures. J Am Acad Orthop Surg 2004; 12 (5): 347–59.
- Kosuge D, Barry M. Changing trends in the management of children’s fractures. Bone Joint J 2015;97-B (4): 442–8.
- Flynn JM, Luedtke LM, Ganley TJ, Dawson J, Davidson RS, Dormans JP, et al. Comparison of titanium elastic nails with traction and a spica cast to treat femoral fractures in children. J Bone Joint Surg Am 2004; 86 (4): 770–7.
- Bopst L, Reinberg O, Lutz N. Femur fracture in preschool children: experience with flexible intramedullary nailing in 72 children. J Pediatr Orthop 2007; 27 (3): 299–303.
- Winquist RA, Hansen Jr ST, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am 1984; 66 (4): 529–39.
- Andreacchio A, Alberghina F, Marengo L, Canavese F. Pediatric tibia and femur fractures in patients weighing more than 50 kg (110 lb): mini-review on current treatment options and outcome. Musculoskelet Surg 2019; 103 (1): 23–30.
- Luo Y, Wang L, Zhao LH, Wang YC, Chen MJ, Wang S, et al. Elastic Stable Titanium Flexible Intramedullary Nails Versus Plates in Treating Low Grade Comminuted Femur Shaft Fractures in Children. Orthop Surg 2019; 11 (4): 664-70.
- Memeo A, Panuccio E, D'Amato RD, Colombo M, Boero S, Andreacchio A, et al. Retrospective, multicenter evaluation of complications in the treatment of diaphyseal femur fractures in pediatric patients. Injury 2019;50 Suppl 4: S60-3.
- Ho CA, Skaggs DL, Tang CW, Kay RM. Use of flexible intramedullary nails in pediatric femur fractures. J Pediatr Orthop 2006; 26 (4): 497–504.
- Han B, Wang Z, Li Y, Xu Y, Cai H. Risk factors for refracture of the forearm in children treated with elastic stable intramedullary nailing. Int Orthop 2019; 43 (9): 2093-7.
- Kamara A, Ji X, Liu T, Zhan Y, Li J, Wang E. A comparative biomechanical study on different fixation techniques in the management of transverse metaphyseal-diaphyseal junction fractures of the distal humerus in children. Int Orthop 2019; 43 (2): 411–6.
- Buechsenschuetz KE, Mehlman CT, Shaw KJ, Crawford AH, Immerman EB. Femoral shaft fracture in children: traction and casting versus casting versus elastic stable intramedullary nailing. J Trauma 2002; 53 (5): 914–21.
- Oh CW, Park BC, Kim PT, Kyung HS, Kim SJ, Ihn JC. Retrograde flexible intramedullary nailing in children’s femoral fractures. Int Orthop 2002; 26 (1): 52–5.
- Kocher MS, Sink EL, Blasier RD, Luhmann SJ, Mehlman CT, Scher DM, et al. Treatment of pediatric diaphyseal femur fractures. J Am Acad Orthop Surg 2009; 17 (11): 718–25.
- Canavese F, Marengo L, Andreacchio A, Mansour M, Paonessa M, Rousset M, et al. Complications of elastic stable intramedullary nailing of femoral shaft fractures in children weighing fifty kilograms (one hundred and ten pounds) and more. Int Orthop 2016; 40 (12): 2627-34.
- Sagan ML, Datta JC, Olney BW, Lansford TJ, McIff TE. Residual deformity after treatment of pediatric femur fractures with flexible titanium nails. J Pediatr Orthop 2010; 30 (7): 638–43.
- Dey S, Mishra K, Nagda TV, Dhamele J, Rathod C, Dey D. Titanium Elastic Nailing with Temporary External Fixator versus Bridge Plating in Comminuted Pediatric Femoral Shaft Fractures: A Comparative Study. Indian J Orthop 2018; 52 (5): 507-12.
- Allen JD, Murr K, Albitar F, Jacobs C, Moghadamian ES, Muchow R. Titanium Elastic Nailing has Superior Value to Plate Fixation of Midshaft Femur Fractures in Children 5 to 11 Years. J Pediatr Orthop 2018; 38 (3): e111-7.
- Alberghina F, Andreacchio A, Cravino M, Paonessa M, Canavese F. Extra-articular proximal femur fractures in children and adolescents treated by elastic stable intramedullary nailing. Int Orthop 2019; 43 (12): 2849-56.
- Kayaokay K, Aktuglu K. Titanium elastic nailing in pediatric femoral diaphyseal fractures in the age group of 6-15 years mid-term and long-term outcomes. Pak J Med Sci 2018; 34 (6): 1529-33.
Titanyum elastik çivi ile tedavi edilmiş pediatrik popülasyondaki femur şaft kırıklarının klinik ve radyografik olarak değerlendirilmesi
Abstract
Amaç: Bu çalışmadaki amaç çocuk femur şaft kırıklarının tedavisinde sık tercih edilen yöntemlerden biri olan titanyum elastik çivinin klinik, fonksiyonel ve radyografik sonuçlarını değerlendirmektir.
Gereç ve Yöntem: Çalışmada Ocak 2018-Aralık 2019 tarihlerinde femur şaft kırığı tanısı almış ve kliniğimizde titanyum elastik çivi yöntemiyle tedavi edilmiş, 4-14 yaş arası ve 50 kg altındaki 33 hasta geriye dönük olarak değerlendirildi. Hastaların demografik bilgileri, yaralanma mekanizması, kırık paterni, cerrahi süresi, radyografik kaynama süresi, kaynama sonrası koronal ve sagital planlardaki rezidü deformite derecesi, kaynamama oranı, bacak boyu eşitsizliği ve ameliyat sonrası yük verme süreleri incelendi.
Bulgular: Femur şaft kırığı erkek çocuklarında kız çocuklarına göre 2,3 kat fazla görülmüştür. Hastalar genellikle trafik kazası ve yüksekten düşme gibi yüksek enerjili travmalar sonucu yaralanmıştır. Radyografik ölçümlere göre koronal planda ortalama 3,23 ± 2,46 derece, sagital planda ise 4,56 ± 3,78 derece rezidü deformite ölçülmüş olup, her iki bacak arasında ortalama 1,36 ± 0,85 cm eşitsizlik tespit edilmiştir. Radyografik kaynama süresi ise ortalama 10,41 ± 3,55 hafta olarak hesaplanmıştır.
Sonuç: Doğru endikasyonla ve doğru teknikle uygulandığı takdirde titanyum elastik çivi tedavisi,15 yaşından küçük ve 50 kg’dan daha az pediatrik popülasyondaki femur şaft kırıklarının tedavisinde son derece önemli ve başarılı bir yöntemdir.
References
- Loder RT, O’Donnell PW, Feinberg JR. Epidemiology and mechanisms of femur fractures in children. J Pediatr Orthop 2006; 26 (5): 561–6.
- Loizou CL, McNamara I, Ahmed K, Pryor GA, Parker MJ. Classification of subtrochanteric femoral fractures. Injury 2010; 41 (7): 739–45.
- Jarvis J, Davidson D, Letts M. Management of subtrochanteric fractures in skeletally immature adolescents. J Trauma 2006; 60 (3): 613–9.
- Pombo MW, Shilt JS. The definition and treatment of pediatric subtrochanteric femur fractures with titanium elastic nails. J Pediatr Orthop 2006; 26 (3): 364–70.
- Ireland DC, Fisher RL. Subtrochanteric fractures of the femur in children. Clin Orthop Relat Res 1975; (110): 157–66.
- Catena N, Sénès FM, Riganti S, Boero S. Diaphyseal femoral fractures below the age of six years: results of plaster application and long term followup. Indian J Orthop 2014; 48 (1): 30–4.
- Flynn JM, Schwend RM, Flynn JM, Schwend RM. Management of pediatric femoral shaft fractures. J Am Acad Orthop Surg 2004; 12 (5): 347–59.
- Kosuge D, Barry M. Changing trends in the management of children’s fractures. Bone Joint J 2015;97-B (4): 442–8.
- Flynn JM, Luedtke LM, Ganley TJ, Dawson J, Davidson RS, Dormans JP, et al. Comparison of titanium elastic nails with traction and a spica cast to treat femoral fractures in children. J Bone Joint Surg Am 2004; 86 (4): 770–7.
- Bopst L, Reinberg O, Lutz N. Femur fracture in preschool children: experience with flexible intramedullary nailing in 72 children. J Pediatr Orthop 2007; 27 (3): 299–303.
- Winquist RA, Hansen Jr ST, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am 1984; 66 (4): 529–39.
- Andreacchio A, Alberghina F, Marengo L, Canavese F. Pediatric tibia and femur fractures in patients weighing more than 50 kg (110 lb): mini-review on current treatment options and outcome. Musculoskelet Surg 2019; 103 (1): 23–30.
- Luo Y, Wang L, Zhao LH, Wang YC, Chen MJ, Wang S, et al. Elastic Stable Titanium Flexible Intramedullary Nails Versus Plates in Treating Low Grade Comminuted Femur Shaft Fractures in Children. Orthop Surg 2019; 11 (4): 664-70.
- Memeo A, Panuccio E, D'Amato RD, Colombo M, Boero S, Andreacchio A, et al. Retrospective, multicenter evaluation of complications in the treatment of diaphyseal femur fractures in pediatric patients. Injury 2019;50 Suppl 4: S60-3.
- Ho CA, Skaggs DL, Tang CW, Kay RM. Use of flexible intramedullary nails in pediatric femur fractures. J Pediatr Orthop 2006; 26 (4): 497–504.
- Han B, Wang Z, Li Y, Xu Y, Cai H. Risk factors for refracture of the forearm in children treated with elastic stable intramedullary nailing. Int Orthop 2019; 43 (9): 2093-7.
- Kamara A, Ji X, Liu T, Zhan Y, Li J, Wang E. A comparative biomechanical study on different fixation techniques in the management of transverse metaphyseal-diaphyseal junction fractures of the distal humerus in children. Int Orthop 2019; 43 (2): 411–6.
- Buechsenschuetz KE, Mehlman CT, Shaw KJ, Crawford AH, Immerman EB. Femoral shaft fracture in children: traction and casting versus casting versus elastic stable intramedullary nailing. J Trauma 2002; 53 (5): 914–21.
- Oh CW, Park BC, Kim PT, Kyung HS, Kim SJ, Ihn JC. Retrograde flexible intramedullary nailing in children’s femoral fractures. Int Orthop 2002; 26 (1): 52–5.
- Kocher MS, Sink EL, Blasier RD, Luhmann SJ, Mehlman CT, Scher DM, et al. Treatment of pediatric diaphyseal femur fractures. J Am Acad Orthop Surg 2009; 17 (11): 718–25.
- Canavese F, Marengo L, Andreacchio A, Mansour M, Paonessa M, Rousset M, et al. Complications of elastic stable intramedullary nailing of femoral shaft fractures in children weighing fifty kilograms (one hundred and ten pounds) and more. Int Orthop 2016; 40 (12): 2627-34.
- Sagan ML, Datta JC, Olney BW, Lansford TJ, McIff TE. Residual deformity after treatment of pediatric femur fractures with flexible titanium nails. J Pediatr Orthop 2010; 30 (7): 638–43.
- Dey S, Mishra K, Nagda TV, Dhamele J, Rathod C, Dey D. Titanium Elastic Nailing with Temporary External Fixator versus Bridge Plating in Comminuted Pediatric Femoral Shaft Fractures: A Comparative Study. Indian J Orthop 2018; 52 (5): 507-12.
- Allen JD, Murr K, Albitar F, Jacobs C, Moghadamian ES, Muchow R. Titanium Elastic Nailing has Superior Value to Plate Fixation of Midshaft Femur Fractures in Children 5 to 11 Years. J Pediatr Orthop 2018; 38 (3): e111-7.
- Alberghina F, Andreacchio A, Cravino M, Paonessa M, Canavese F. Extra-articular proximal femur fractures in children and adolescents treated by elastic stable intramedullary nailing. Int Orthop 2019; 43 (12): 2849-56.
- Kayaokay K, Aktuglu K. Titanium elastic nailing in pediatric femoral diaphyseal fractures in the age group of 6-15 years mid-term and long-term outcomes. Pak J Med Sci 2018; 34 (6): 1529-33.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | December 22, 2021 |
| Submission Date | January 5, 2021 |
| Published in Issue | Year 2021Volume: 60 Issue: 4 |
