DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20164829

Comparative study of the outcome of pediatric femur diaphyseal fractures treated with titanium elastic nails vs. compression plates

Angad Jolly, Neelanagowda V. Patil, Rahul Bansal, Veeresh Pattanshetti

Abstract


Background: A variety of methods have been described for the management of femur diaphyseal fractures in children between ages of 5 to 12 years. Some of the techniques include closed reduction and internal fixation (CRIF) with elastic nails, open reduction and internal fixation (ORIF) with compression plates, external fixators and skeletal traction with spica casting. This study was done to compare the outcome and complications of diaphyseal femur fractures in pediatric age treated with CRIF with Titanium elastic nails vs. ORIF with compression plates.

Methods: The study was a prospective, clinical study.  A total of 60 patients were studied. 30 patients were treated with CRIF with titanium nails and 30 patients were treated with ORIF with compression plates. Every patient operated was followed up at 3 weeks, 6 weeks, 3 months, 6 months and 3 monthly thereafter until implant removal.

Results: Only 1 wound healing complication was noted in the TENS nail group which was skin irritation at the site of pin insertion. In the compression plating group, 6 patients developed wound complications, including superficial infections, deep infections and keloids. The range of movements at knee joint in the two groups was compared.  Only 1 patient had a significant loss of flexion with ROM of less than 100 degrees in the TENS nail group. In the plating group 4 patients had a significant loss of flexion with ROM of less than 100 degrees. Limb length discrepancies were seen in 3 patients in the TENS nail group whereas the compression plating group showed 1 patient. 2 patients in the TENS group developed an angular deformity due to premature weight bearing.  3 patients in the compression plating group developed deformities at the fracture site. The average time for fracture union in the compression plate group was 10.7 weeks and was 14.7 weeks in the patients treated with TENS nail.

Conclusions: No single fixation method can be considered superior in all types and patterns of pediatric diaphyseal femur fractures. Titanium elastic nails can be considered a better implant for treating pediatric femur fractures when compared to compression plates due to the lesser rates of surgical wound complications, better range of movements at knee joint and overall lesser complication rate as was recorded in this study.


Keywords


Titanium elastic nail, Compression plate, Pediatric femur fracture

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References


Canale ST, Beaty JH. Campbell's Operative Orthopaedics. 12th Edition. Chicago: Mosby; 2012.

Carey TP, Galpin RD. Flexible intramedullary nail fixation of paediatric femoral fractures. Clin Orthop Relat Res. 1996;332:110-8.

Heyworth B, Galano G, Vitale M, Vitale M. Management of closed femoral shaft fractures in children, ages 6 to 10: national practice patterns and emerging trends. J Pediatr Orthop. 2004;24(5):455-9.

Lodar R, O’Donnell P, Feinberg J. Epidemiology and mechanisms of femur fractures in children. J Pediatr Orthop. 2006;26(5):561–6.

Flynn J, Hresko T, Reynolds R, Blasier R, 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.

Narayanan U, Hyman J, Wainwright A, Rang M, Alman B. Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them. J Pediatr Orthop. 2004;24:363–9.

Sink E, Hedequist D, Morgan S, Hresko T. Results and technique of unstable pediatric femoral fractures treated with submuscular bridge plating. J Pediatr Orthop. 2006;26(2):177-81.

Aronson J, Tursky EA. External fixation of femur fractures in children. J Pediatr Orthop. 1992;12(2):157-63.

Beaty JH, Austin SM, Warner WC, Canale ST, Nichols L. Interlocking intramedullary nailing of femoral-shaft fractures in adolescents: preliminary results and complications J Pediatr Orthop. 1994;14(2):178-83.

Fein LH, Pankovich AM, Spero CM, Baruch HM. Closed flexible intramedullary nailing of adolescentfemoral shaft fractures. J Orthop Trauma. 1989;3:133-41.

Kissel EU, Miller ME. Closed-ended nailing of femur fractures in older children. J Trauma. 1989;29:1585-8.

Mann DC, Weddington J, Davenport K. Closed Ender nailing of femoral shaft fractures in adolescents. J Pediatr Orthop. 1986;6(6):651-5.

Kocher MS, Sink EL, Blasier RD, Luhmann SJ, Mehlman CT, Scher DM, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of pediatric diaphyseal femur fracture. J Bone Joint Surg Am. 2010;17(11):718-25.

Rasool MN, Govender S, Naidoo KS. Treatment of femoral shaft fractures in children by early spica casting. S Afr Med J. 1989;76(3):96-9.

Raney EM, Ogden JA, Grogan DP. Premature greater trochanteric epiphysiodesis secondary to intramedullary femoral rodding. J Pediatr Orthop. 1993;13:516–20.

Ligier JN, Metaizeau JP, Prévot J, Lascombes P. Elastic stable intramedullary nailing of femoral shaft fractures in children. J Bone Joint Surg Br. 1988;70(1):74-7.

Flynn JM, Luedtke LM, Ganly TG. Comparison of titanium elastic nails with traction and spica cast to treat femoral fractures in children. J Bone Joint Surg Am. 2004;86(4):770-7.

Moroz LA, Launay F, Kocher MS, Newton PO, Frick SL, Sponseller PD, et al. Titanium elastic nailing of fractures of the femur in children. Predictors of complications and poor outcome. J Bone Joint Surg Br. 2006;88(10):1361–6.

Sink EL, Gralla J, Repine M. Complications of pediatric femur fractures treated with titanium elastic nails: a comparison of fracture types. J Pediatr Orthop. 2005;25(5):577-80.

Ellis HB, Ho CA, Podeszwa DA, Wilson PL. A comparison of locked versus nonlocked Enders rods for length unstable pediatric femoral shaft fractures. J Pediatr Orthop. 2011;31(8):825-33.

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.

Flynn JM, Luedtke L, Ganley TJ, Pill SG. Titanium elastic nails for pediatric femur fractures: lessons from the learning curve. Am J Orthop (Belle Mead NJ). 2002;31(2):71-4.

Porter SE1, Booker GR, Parsell DE, Weber MD, Russell GV, Woodall J Jr, et al. Biomechanical analysis comparing titanium elastic nails with locked plating in two simulatedpediatric femur fracture models. J Pediatr Orthop. 2012;32(6):587-93.

Becker T, Weigl D, Mercado E, Katz K, Bar-On E. Fractures and refractures after femoral locking compression plate fixation in children and adolescents. J Pediatr Orthop. 2012;32(7):40-6.

Caird MS, Mueller KA, Puryear A, Farley FA. Compression plating of pediatric femoral shaft fractures. J Pediatr Orthop. 2003;23(4):448-52.