Can titanium elastic nail be safely used for paediatric subtrochanteric femur fractures?

Abstract

In this study, we aimed to show that subtrochanteric femur fractures, an uncommon type of fracture in the paediatric age group, can be treated with titanium elastic nailing (TEN). We reviewed the patients treated with TEN in the paediatric age group with subtrochanteric femur fractures who had been treated at the Orthopaedics and Traumatology Clinic of Izmir Tepecik Research and Training Hospital between January 2011 and December 2016 retrospectively. All fractures were fixed by retrograde nailing with supracondylar entry following reduction. Patients’ demographics as well as data such as fracture type, fracture level, time of operation, reduction type, time to union, shortness, additional fixation, duration of additional fixation, Flynn scores and reduction loss were evaluated. The 20 patients included in our study were followed up for at least 1 year, had an age range of 54–173 months (mean, 104 ± 31.82 months) and were operated within 2–11 days after fracture. All patients had fracture union and only three patients had union with an angulation of less than 5°. None of the patients had limb length inequality. Fourteen patients underwent reoperation, all of these were routine operations for implant removal and no patients required reoperation for complications. We think that paediatric subtrochanteric femur fractures can be treated by TEN fixation using the proper technique, with a limited invasive intervention.

Operative choice for subtrochanteric femoral fracture in school-aged children: Triple elastic stable intramedullary nail versus locking plate

“…If the fracture site demonstrated > 1 cm displacement or translation or > 15 degrees angulation, a third ESIN was inserted from the lateral incision of the distal femur. Besides, in our study, there was no patient with malunion or severe angulation in the group of TE, consistent with the previous study ( 8 , 20 ).…”

“…In contrast, some authors espoused the applications of double nails for pediatric subtrochanteric fractures with satisfactory outcomes (6)(7)(8)20). Certain techniques, including the placement of nails in the femoral neck or the nail's perforation of the femoral neck cortex, were recommended in these articles (8,20). At our institute, double and triple nails were adopted for this condition.…”

“…In the aforementioned studies, double nails were adopted. In contrast, some authors espoused the applications of double nails for pediatric subtrochanteric fractures with satisfactory outcomes ( 6 – 8 , 20 ). Certain techniques, including the placement of nails in the femoral neck or the nail’s perforation of the femoral neck cortex, were recommended in these articles ( 8 , 20 ).…”

Titanium elastic nails vs locking plate in pediatric subtrochanteric femur fractures: A systematic review and meta-analysis

“…This study also confirmed no significant difference in the Harris score at the end hip, indicating better recovery of hip function after both types of internal fixation. However, Basa et al (21) found satisfactory clinical results with TEN for any type of subtrochanteric fracture in children without severe rotational or inversion deformities. The study by Alberghina et al (22) also concluded that displaced subtrochanteric fractures of the femur under 14 years of age achieved good results with TEN, but the studies by Basa et al (21) and Alberghina et al (22) lacked a controlled comparison with locking plates and could not show that TENs are superior to splints in the treatment of comminuted and unstable subtrochanteric fractures in children.…”

Can titanium elastic nail be safely used for paediatric subtrochanteric femur fractures? Basa CD, Kacmaz IE, Zhamilov V, Reisoglu A, Agus A. J Pediatr Orthop B 2021; 30:1–5.

“…We read with interest the publication by Basa et al [1], 'Can titanium elastic nail be safely used for paediatric subtrochanteric femur fractures?' The authors [1] stated that fractures treated with titanium elastic nails (TEN) may lose reduction if not treated according to the method described by Lascombes et al [2]. The latter authors stated that TENs must be bend so that the vertex is at the level of the fracture, but Basa et al [1] included radiographs showing that the recommended surgical technique was not adhered to, with the vertex of both TENs being a long distance away from the fracture, creating a construct with reduced stability.…”