Functional outcome of femoral shaft fracture in pediatric patients treated by titanium elastic nailing system
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20242386Keywords:
Functional outcome, Femoral shaft fracture, Pediatric patients, TENSAbstract
Background: Pediatric femoral shaft fractures are common, typically occurring in early childhood due to low-energy incidents and during adolescence due to high-energy trauma. These fractures represent around 2.2% of all bone injuries in children, with an incidence of 20-25 per 100,000 children per year, and are more prevalent in boys.
This prospective study aims to assess the outcomes of treating pediatric femoral shaft fractures with TENs.
Methods: This prospective study at North Bengal Medical College and Hospital included Twenty-three patients, aged 4 to 12 years, with diaphyseal femur fractures treated using TENS (Titanium Elastic Nailing System) for one year, from January 2023 to December 2023.
Results: Most patients (52.17%) were 9-12, with a higher prevalence of males (73.91%). The most common fracture type was transverse (69.57%), predominantly on the right side (69.57%). Union rates were 21.74% at 8 weeks, 56.52% at 10, and 21.74% at 12 weeks. Complications included limb lengthening (21.74%) and malalignment (13.04%). Functional outcomes at 12 weeks post-operation were mostly excellent (60.87%) or satisfactory (30.43%), with one poor result (8.70%).
Conclusions: Titanium elastic nailing system (TENS) is effective for pediatric femoral shaft fractures, achieving high bone union rates and minimal complications. Most fractures healed within 10 weeks, and patients had excellent or satisfactory functional outcomes, supporting TENS as a beneficial treatment for children aged 4 to 14.
References
Bhaskar A. Treatment of long bone fractures in children by flexible titanium elastic nails. Indian J Orthop. 2005;39(3):166-8.
John R, Sharma S, Raj GN, Singh J, Varsha C, Arjun RH, et al. Suppl 2: M4: Current concepts in paediatric femoral shaft fractures. The open orthop J. 2017;11:353.
Flynn JM, Schwend RM. Management of pediatric femoral shaft fractures. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2004;12(5):347-59.
Agarwal-Harding KJ, Meara JG, Greenberg SL, Hagander LE, Zurakowski D, Dyer GS. Estimating the global incidence of femoral fracture from road traffic collisions: a literature review. JBJS. 2015;97(6):31.
Henderson J, Goldacre MJ, Fairweather JM, Marcovitch H. Conditions accounting for substantial time spent in hospital in children aged 1-14 years. Archives of disease in childhood. Arch Dis Child. 1992;67(1):83-6.
Younis MH, Mahmoud K, Kawas A, Ibrahim T. Early versus late hip spica casting for paediatric femoral shaft fractures. J Ped Orthop B. 2019;28(2):122-6.
Kim EJ, Crosby Jr SN, Mencio GA, Green NE, Lovejoy SA, Schoenecker JG, et al. Rigid intramedullary nailing of femoral shaft fractures in skeletally immature patients using a lateral trochanteric entry portal. JBJS Essential Surgical Techniques. 2014;4(4):19.
Khan AA, Jaiswal RK, Dhanraj P, Sai K, Kumar CP. Functional outcome of pediatric femoral shaft fractures treated with TENS nailing: A case series of 25 patients. Int J of Orthop. 2023;9(1):287-92.
Debnath D, Haq MR, Islam SJ, Islam T. Comparative Study of Paediatric Femur Shaft Fracture Treated With TENS and DCP. EAS J Orthop Physiother. 2023;23;5(4):1-7.
Kasser JR. Femoral shaft fractures. Fractures in children and Adolescents. J Trauma. 2001;51(6):1182-8
Buckley SL. Current trends in the treatment of femoral shaft fractures in children and adolescents. Clin Orthop Related Res (1976-2007). 1997;338:60-73.
Chincholi S. Management of paediatric femoral shaft fractures with titanium elastic nails. J Pediatr Orthop. 2016;2(4):106-8.
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 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. JBJS. 2004;86(4):770-7.
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. JBJS. 2004;86(4):770-7.
Buechsenschuetz KE, Mehlman CT, Shaw KJ, Crawford AH, Immerman EB. Femoral shaft fractures in children: traction and casting versus elastic stable intramedullary nailing. J Trauma Acute Care Surg. 2002;53(5):914-21.
Reeves RB, Ballard RI, Hughes JL. Internal fixation versus traction and casting of adolescent femoral shaft fractures. J Ped Orthop. 1990;10(5):592-5.
Siddiqui AA, Abousamra O, Compton E, Meisel E, Illingworth KD. Titanium elastic nails are a safe and effective treatment for length unstable pediatric femur fractures. J Pediatr Orthop. 2020;40(7):560-5.
Sandhu KS, Kaur M, Singh H, Sandhu A. Evaluation of outcome, safety, and efficacy of diaphyseal fracture of femur and tibia in children-treated by titanium elastic nailing system (TENS). EJMCR. 2021;8:4000-10.
El-Adl G, Mostafa MF, Khalil MA, Enan A. Titanium elastic nail fixation for paediatric femoral and tibial fractures. Acta Orthopædica Belgica. 2009;75(4):512.
Choudhari P, Chhabra S, Kiyawat V. Evaluation of s results of titanium elastic nailing system in paediatric lower extremity fractures of long bones. J Evol Med Dent Sci. 2014;3(72):15303-10.
Khazzam M, Tassone C, Liu XC, Lyon R, Freeto B, Schwab J, Thometz J. Use of flexible intramedullary nail fixation in treating femur fractures in children. Am J Orthop. 2009;38(3):E49-55.
Kumar YS. A prospective study of functional outcome of treatment of fracture shaft femur in children using titanium elastic nails system. IJHCR. 2021;4:103-5.
Lohiya R, Bachhal V, Khan U, Kumar D, Vijayvargiya V, Sankhala SS, et al. Flexible intramedullary nailing in paediatric femoral fractures. A report of 73 cases. J Orthop Surg Res 2011;6:1-1.
Singh R, Sharma SC, Magu NK, Singla A. Titanium elastic nailing in pediatric femoral diaphyseal fractures. Indian J Orthop. 2006;40(1):29-34.
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
