Biomechanical Analysis of Titanium Elastic Nail Fixation in a Pediatric Femur Fracture Model

Li, Ying; Stabile, Kathryne J.; Shilt, Jeffrey S.

doi:10.1097/bpo.0b013e31818f1136

Cited by 56 publications

(44 citation statements)

References 14 publications

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“…Narayanan et al (23) observed that comminuted fractures that compromised more than 25% of the femoral diaphysis presented higher rates of pseudarthrosis or delayed union, thus suggesting that the stability should be increased using external fixation (18) , thereby protecting the reduction, especially in the sagittal plane, as reported by Mani et al (24) . Luhmann et al (13) concluded that fixation of femoral fractures in overweight patients and use of flexible intramedullary nails of smaller diameter were associated with greater sagittal angles, and that the coronal angle was correlated with the size of the nail, with technical failure also involved.…”

Section: Discussionmentioning

confidence: 71%

“…the length of the fracture was greater than the diameter of the femur at the level of the fracture) (15,18) ; -treated using elastic intramedullary nails made of titanium, with retrograde insertion; and -minimum follow-up of 36 months. The exclusion criteria were as follows: -stable femoral fractures; -fractures in bones presenting pathological conditions; -fractures in the metaphyseal region; and -cases in which the approach chosen was anterograde insertion of the flexible intramedullary nails made of titanium.…”

Section: Introductionmentioning

confidence: 99%

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Fraturas instáveis do fêmur em crianças tratadas com hastes intramedulares elásticas de titânio

et al. 2012

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ABSTRACTdiaphysis fractures treated with elastic titanium intramedullary nails with retrograde insertion were included in the study. There were two bilateral fractures and two exposed fractures. Seven patients were female and 17 were male, and the mean age was 8.3 years. The following were presented at the end of the study: shortening, varus or valgus displacement, final retrocurvatum or antecurvatum of zero, and absence of delayed consolidation or pseudarthrosis. Conclusions: The elastic titanium intramedullary nails were easily placed and removed. We believe that using elastic titanium intramedullary nails is a good option for fixation of unstable femoral fractures in children.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Fraturas instáveis do fêmur em crianças tratadas com hastes intramedulares elásticas de titânio

et al. 2012

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“…The authors noted that weight greater than 40-45 kgs provides a load at which permanent sagittal and coronal deformation of the nail can occur [27]. Salem et al [21] reported similarly high rates of torsional differences>15°in 50% of 68 children who underwent elastic nailing of femur fractures.…”

Section: Elastic Intramedullary Nailingmentioning

confidence: 70%

Management of pediatric diaphyseal femur fractures

Heyworth

Suppan

Kramer

et al. 2012

Curr Rev Musculoskelet Med

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A variety of strategies are utilized for management of pediatric diaphyseal femur fractures, depending chiefly on the age of the patient. Other factors that can influence the selection of a technique-which range from skeletal traction with spica casting to immediate spica casting, flexible intramedullary nailing, rigid intramedullary rodding, or plate fixation-are weight, fracture severity, associated injuries, and underlying medical or musculoskeletal conditions. The available evidence regarding technique, outcomes, and complications of the aforementioned treatment options remains largely insufficient, and, at times, conflicting, which contributes to the challenges in management decisions. Considerable controversy has arisen over several topics, particularly the optimal treatment for patients aged 5 to 12 years and accepted standards of treatment. This review is designed to provide perspective for some of the most recent influential literature on pediatric diaphyseal femur fracture treatment in light of established evidence and evolving controversies.

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“…Care is required when indicating flexible intramedullary nails for patients who are obese and closer to skeletal maturity, and an indication for an interlocking pediatric nail with a lateral entry point should be considered. 5,[33][34][35] In order to provide better control over the alignment of unstable fractures, such as comminuted, long oblique or spiral fractures, and in cases of fractures in heavy patients, a new device (end caps) was designed by the AO expert group to address these complications. 36 …”

Section: Shortening Overgrowth and Deformitiesmentioning

confidence: 99%

Flexible intramedullary nails with traction versus plaster cast for treating femoral shaft fractures in children: comparative retrospective study

et al. 2013

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CONTEXT AND OBJECTIVE: Femoral fractures are common in children between 2 and 12 years of age, and 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as conservative treatment. However, in some situations, a surgical approach is recommended. The objective here was to compare treatments for femoral shaft fractures using intramedullary nails (titanium elastic nails, TEN) versus traction and plaster casts in children. The hypothesis was that TEN might provide better treatment, with good clinical results in comparison with plaster casts. DESIGN AND SETTING: This retrospective comparative study was conducted in a public university hospital. METHODS: Sixty children with femoral fractures were evaluated; 30 of them underwent surgical treatment with TEN and 30 were treated conservatively using plaster casts. The patients' ages ranged from 5 to 13 years (mean of 9 years). RESULTS:The mean duration of hospitalization was nine days for the surgical group and 20 days for the conservative group. The incidence of overgrowth in the patients treated with TEN was 60.0% and, for those treated conservatively, 13.3%. Partial weight-bearing was allowed after 3.5 weeks in the surgical group and after 9.6 weeks in the conservative group. New hospitalization was required for 90.0% in the surgical group and 16.7% in the conservative group. Patients treated with plaster casts presented higher incidence of complications, such as loss of reduction. CONCLUSIONS: The surgical method presented better results for children. RESUMO CONTEXTO E OBJETIVO:Fraturas femorais são comuns em crianças entre 2 e 12 anos de idade, e 75% das lesões acometem a diáfise. Tração seguida de aparelho gessado ("gesso") é universalmente aceita como tratamento conservador. Entretanto, em algumas situações o tratamento cirúrgico é recomendado. O objetivo foi comparar o tratamento de fraturas diafisárias do fêmur com hastes intramedulares (titanium elastic nails, TEN) com tração e gesso em crianças. A hipótese era de que TEN pode ser melhor tratamento, com bons resultados clínicos em comparação com o gesso. TIPO DE ESTUDO E LOCAL: Este estudo retrospectivo e comparativo foi conduzido num hospital público universitário. MÉTODOS: Sessenta crianças com fraturas de fêmur foram avaliadas, 30 delas foram submetidas a tratamento cirúrgico com TEN e 30 foram tratadas de forma conservadora usando gesso. A idade dos pacientes variou de 5 a 13 anos (média de 9 anos). RESULTADOS: O tempo médio de internação foi de 9 dias para o grupo cirúrgico e 20 dias para o grupo conservador. A incidência de crescimento excessivo nos pacientes tratados com TEN foi de 60,0% e, para aqueles tratados de forma conservadora, 13,3%. Sustentação parcial de peso foi permitida após 3,5 semanas no grupo cirúrgico e após 9,6 semanas no grupo conservador. Houve 90,0% de novas internações no grupo cirúrgico e 16,7% no grupo conservador. Pacientes tratados com gesso apresentaram maior incidência de complicações, tais como perda de redução. CONCLUS...

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Biomechanical Analysis of Titanium Elastic Nail Fixation in a Pediatric Femur Fracture Model

Abstract: Our study provides biomechanical evidence that patients weighing more than 40 to 45 kg who undergo stabilization of a transverse midshaft femur fracture with titanium elastic nails are at risk for loss of reduction in the sagittal and coronal planes.

Cited by 56 publications

References 14 publications

Fraturas instáveis do fêmur em crianças tratadas com hastes intramedulares elásticas de titânio

Fraturas instáveis do fêmur em crianças tratadas com hastes intramedulares elásticas de titânio

Management of pediatric diaphyseal femur fractures

Flexible intramedullary nails with traction versus plaster cast for treating femoral shaft fractures in children: comparative retrospective study

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