Clinical evaluation of end caps in elastic stable intramedullary nailing of femoral and tibial shaft fractures in children

Slongo, Theddy; Audigé, Laurent; Hunter, J. B.; Berger, Steffen

doi:10.1007/s00068-011-0091-8

Cited by 21 publications

(10 citation statements)

References 26 publications

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“…In contrast, Volpon and co-workers described during combined axial-bending tests the TEN + CAP combination to be 8.75 % stiffer than nails alone as well as during torsion tests a 14 % increased stiffness in (rare) distal femoral fractures [ 22 ]. Their data tend to be congruent with preliminary clinical results in few patients [ 23 , 24 ]. Therefore, the aim of this study was to determine the influence of these two interesting and intensively discussed modifications with end caps and a third nail (end caps = 2CEC; third nail = 3E) to improve the stiffness of the classical C-shaped elastic stable intramedullary nailing osteosynthesis (2C) in displaced transverse femoral fractures in all possible stress planes.…”

Section: Introductionsupporting

confidence: 83%

“…In contrast, we are certain that, considering the complex treatment problems, femur fractures require testing in all stress planes as in our previous in vitro settings [ 18 – 21 ]. With the aim of achieving further improvement in the ESIN technique, we tested two different modifications (end caps and a third nail), both established clinically in case series [ 21 , 24 ] but not yet well analysed in a validated biomechanical model of a transverse femoral fracture. Only one study focussed on end caps in a transverse fracture model but in a very distal fracture type, which is a less frequent transverse shaft fracture.…”

Section: Discussionmentioning

confidence: 99%

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Improving stability of elastic stable intramedullary nailing in a transverse midshaft femur fracture model: biomechanical analysis of using end caps or a third nail

et al. 2015

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BackgroundElastic stable intramedullary nailing (ESIN) is accepted widely for treatment of diaphyseal femur fractures in children. However, complication rates of 10 to 50 % are described due to shortening or axial deviation, especially in older or heavier children. Biomechanical in vitro testing was performed to determine whether two modified osteosyntheses with end caps or a third nail could significantly improve the stability in comparison to classical elastic stable intramedullary nailing in a transverse femur fracture model.MethodsWe performed biomechanical testing in 24 synthetic adolescent femoral bone models (Sawbones®) with a transverse midshaft (diaphyseal) fracture. First, in all models, two nails were inserted in a C-shaped manner (2 × 3.5 mm steel nails, prebent), then eight osteosyntheses were modified by using end caps and another eight by adding a third nail from the antero-lateral (2.5-mm steel, not prebent). Testing was performed in four-point bending, torsion, and shifting under physiological 9° compression.ResultsThe third nail from the lateral showed a significant positive influence on the stiffness in all four-point bendings as well as in internal rotation comparing to the classical 2C configuration: mean values were significantly higher anterior-posterior (1.04 vs. 0.52 Nm/mm, p < 0.001), posterior-anterior (0.85 vs. 0.43 Nm/mm, p < 0.001), lateral-medial (1.26 vs. 0.70 Nm/mm, p < 0.001), and medial-lateral (1.16 vs. 0.76 Nm/mm, p < 0.001) and during internal rotation (0.16 vs. 0.11 Nm/°, p < 0.001). The modification with end caps did not improve the stiffness in any direction.ConclusionsThe configuration with a third nail provided a significantly higher stiffness than the classical 2C configuration as well as the modification with end caps in this biomechanical model. This supports the ongoing transfer of the additional third nail into clinical practice to reduce the axial deviation occurring in clinical practice.

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Section: Introductionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Improving stability of elastic stable intramedullary nailing in a transverse midshaft femur fracture model: biomechanical analysis of using end caps or a third nail

et al. 2015

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“…The potential for correction of deformity is great in infancy but largely disappears by the beginning of adolescence [ 11 ]. The biomechanical behaviour of a heavy teenager’s bone is often far closer to that of an adult patient than a child [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

The management of paediatric diaphyseal femoral fractures: a modern approach

Khoriati¹,

Jones²,

Gelfer³

et al. 2016

Strategies in Trauma and Limb Reconstruction

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The definitive treatment of paediatric femoral diaphyseal fractures remains controversial. Modalities of treatment vary mostly according to age, with fracture pattern and site having a lesser impact. Current evidence is reflective of this variation with most evidence cited by the American Academy of Orthopedic Surgeons being level 4 or 5. The authors present a review of the most up-to-date evidence relating to the treatment of these fractures in each age group. In an attempt to clarify the current trends, we have produced an algorithm for decision-making based on the experience from our own tertiary referral level 1 major trauma centre.

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“…5), ermöglicht jedoch auch bei längsinstabilen Frakturen in vielen Fällen eine sichere Osteosynthese. Diese Modifikation wurde sowohl biomechanisch als auch klinisch evaluiert [13,14].…”

Section: Wachstumsprognoseunclassified

Behandlung der Femurschaftfraktur im Wachstumsalter

Kertai

2017

Trauma Berufskrankh

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Behandlung der Femurschaftfraktur im Wachstumsalter Vom Beckenbeingips bis zur elastisch stabilen intramedullären Nagelung Inzidenz und Pathophysiologie Frakturen des Femurschaftes machen etwa 1-3 % aller Frakturen im Wachstumsalter aus [1, 2]. Hierbei zeigt die Altersverteilung 2 wesentliche Altersgipfel: Der erste Gipfel liegt zwischen dem 2. und 4. Lebensjahr, der zweite im Alter der Pubertät [3]. Etwa ein Drittel aller Femurschaftfrakturen findet sich bei Kindern bis zum 3. Lebensjahr. Dieser Häufigkeitsgipfel erklärt sich durch den primär weichen Aufbau des Femur beim Neugeborenen und den erst in den ersten Lebensjahren vollzogenen Umbau zum laminären Abb. 1 8 Konservative Behandlung einer misshandlungsbedingten Femurschaftfraktur mit Overheadextension bei einem 7 Monate alten Kind. Nach 2 1/2 Wochen zeigt sich bereits eine ausreichende Konsolidierung. a Röntgen am Aufnahmetag, b Konsolidation nach 2 1/2 Wochen in der Overhead-Extension Abb. 2 8 Overheadextension bei einem 2-jährigen Kind Trauma und Berufskrankheit • Suppl 1 • 2018 S1

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Clinical evaluation of end caps in elastic stable intramedullary nailing of femoral and tibial shaft fractures in children

Cited by 21 publications

References 26 publications

Improving stability of elastic stable intramedullary nailing in a transverse midshaft femur fracture model: biomechanical analysis of using end caps or a third nail

Improving stability of elastic stable intramedullary nailing in a transverse midshaft femur fracture model: biomechanical analysis of using end caps or a third nail

The management of paediatric diaphyseal femoral fractures: a modern approach

Behandlung der Femurschaftfraktur im Wachstumsalter

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