Clinical and radiological evaluation of minimally invasive intramedullary fixation by titanium elastic nails in paediatric long bone fractures of lower limb: a prospective study


  • A. Sandeep Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
  • Jayant Jain Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India



Femur diaphyseal fractures, Tibial diaphyseal fractures, Titanium


Background: Elastic stable intramedullary nailing for the treatment of paediatric femur and tibial diaphyseal fractures was introduced by Prevot and colleagues in 1979. It follows three-point fixation principle that provides internal support in presence of cortical contact and an intact soft-tissue envelope. This technique has many advantages, including better reduction, dynamic axial stabilization, shorter hospitalization with early rehabilitation and low complication rate.

Methods: This is a prospective observational study done at Kauvery Medical Centre, Trichy between May 2017 to May 2018 consisting of 39 children between age 5 to 16 years with diaphyseal fractures of femur and tibia. The fractures were treated by closed reduction and internal fixation with titanium elastic intramedullary nailing. The patients were evaluated clinically and radiologically and followed for an average of 6 months. Outcome was assessed using transcutaneous electrical nerve stimulation (TENS) scoring system used by Flynn et al.

Results: Our series consisted of 39 patients (22 cases with fracture shaft of femur and 17 cases with fracture shaft of tibia), 33 males and only 6 females. Average time for radiological union was 9.89 weeks. All patients had full range of hip and ankle motion and 2 (5.1%) patients had mild restriction in knee flexion at 12 weeks.

Conclusions: Elastic stable intramedullary nailing is an ideal method for treatment of paediatric femoral and tibial diaphyseal fractures due to lower complication rate and good functional outcome in comparison to other methods of treatment.


Metaizeau JP. Osteosynthesis in children: techniques and indications (in French). Chir Pédiatr 1983;69:495-511.

Metaizeau JP. Osteosynthèse chez l' Enfant: Embrochage Centro Médullaire Elastique Stable. Montpellier: Sauramps Med Diffusion Vigot; 1988: 61-102.

Beaty JH, Austin SM, Warner WC et al. Interlocking intramedullary nailing of femoral shaft fractures in adolescents: preliminary results and complications. J Pediatr Orthop. 1994;14:178-83.

Momberger N, Stevens P, Smith J, Santora S, Scott S, Anderson J. Intramedullary nailing of femoral fractures in adolescents. J Pediatr Orthop. 2000;20:482-4.

Ligier JN., Metaizeau JP, Prevot J, Lascombes P. Elastic stable intramedullary nailing of femur fracture in children. J Bone Joint Surg (Br). 1988;70:74-7.

Saikia KC, Bhuyan SK, Bhattacharya TD, Saikia SP. Titanium elastic nailing in femoral diaphyseal fractures of children in 6-16 years of age. Indian J Orthop. 2007;41:381-5.

Cramer KE, Tornetta P. III, Spero CR, Alter S, Miraliakbar H, Teefey J. Ender rod fixation of femoral shaft fracture in children. Clin Orthop Rel Res. 2000;376:119-23.

Shannak AO. Tibial fractures in children: follow-up study. J Pediatr Orthop. 1988;8:306–10.

Siegmeth A, Wruhs O, Vecsei V. External fixation of lower limb fractures in children. Eur J Pediatr Surg. 1998;8:35–41.

Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J. Titanium elastic nails for pediatric femur fractures–– a multicenter study of early results with analysis of complications. J Pediatr Orthop. 2001;21(1):4–8

O’Brien T, Weisman DS, Ronchetti P, Piller CP, Maloney M. Flexible titanium elastic nailing for the treatment of the unstable pediatric tibial fracture. J Pediatr Orthop. 2004;24(6):601–9.

Wudbhav N. Sankar, Kristofer J. Jones, B. David Horn, and Lawrence Wells. Titanium elastic nails for pediatric tibial shaft fractures. J Child Orthop. 2007;1(5):281-6.

El-Adl G, Mostafa MF, Khalil MA, Enan A. Titanium elastic nail fixation for paediatric femoral and tibial fractures. Acta Orthop Belg. 2009;75:512-20.

Khurram BARLAS, Humayun Beg Flexible intramedullary nailing versus external fixation of paediatric femoral fractures Acta Orthop Belg. 2006;72:159-63.

Oh CW, Park BC, Kim PT, Kyung HS, Kim SJ, Inn JC. Retrograde flexible intramedullary nailing in children’s femoral fractures. Int Orthop. 2002;26(1):52-5.

Aksoy C, Caolar O, Yazyoy M, Surat A. Pediatric femoral fractures A comparison of compression plate fixation and flexible intramedullary nail fixation. J Bone Joint Surg (Br). 2003;85(3):263.

Ozturkman Y, Dogrul C, Balioglu MB, Karli M. Intram, edullary stabilization of pediatric diaphyseal femur fracture with elastic ender nails. Acta Orthop Traumatol Turc. 2002;36(3):220-7.

Carey TP, Galpin RD. Flexible intramedullary nail fixation of pediatric femoral fractures. Clin Orthop. 1996;332:110–8.

Heinrich SD, Mooney JF. Fractures of the shaft of the tibia and fibular. In: Rockwood and Wilkins' Fractures in Children. 4th edition, Wilkins KE, Beaty JH, Eds. Philadelphia: Lippincott Williams & Wilkins; 2006: 1033.

Bar-on E, Sagiv S, Porat S. External fixation or flexible intramedullary nailing for femoral shaft fractures in children. J Bone Joint Surg (Br). 1997;79:975-8.






Original Research Articles