Complications of Elastic Stable Intramedullary Nailing for treating paediatric long bone fractures

Nisar, A.; Bhosale, Abhijit; Madan, Sanjeev; Flowers, M.J.; Fernandes, James A.; Jones, Scott

doi:10.1016/j.jor.2013.01.003

Cited by 46 publications

(29 citation statements)

References 35 publications

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“…Although being rare when appropriate technique is used, some weaknesses have been reported in ESIN 13,15,21,22 . A metallic implant predisposes the patient to bacterial infections, may cause local pain and soft-tissue irritation [23][24][25][26] and may interfere with radiological imaging. Radial nerve lesion, delayed union, nonunion, re-fracture 27 and compartment syndrome may occur 5,10,19,21,22 .…”

Section: Introductionmentioning

confidence: 99%

Intramedullary nailing of forearm shaft fractures by biodegradable compared with titanium nails: Results of a prospective randomized trial in children with at least two years of follow-up

et al. 2018

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Section: Introductionmentioning

confidence: 99%

Intramedullary nailing of forearm shaft fractures by biodegradable compared with titanium nails: Results of a prospective randomized trial in children with at least two years of follow-up

et al. 2018

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“…Of the excluded full texts, the most common reason for exclusion was that open fractures could not be separated (10 studies) [19][20][21][22][23][24][25][26][27][28] followed by studies with too small population (7 studies). [29][30][31][32][33][34][35] In two studies, 36,37 distal tibia fractures were no distinguishable from diaphyseal fractures, and two studies 38,39 reported only the incidence of compartment syndrome. Three additional studies reporting only epidemiological data, 40 surgical technique, 41 and long-term outcomes, 42 respectively, were excluded.…”

Section: Resultsmentioning

confidence: 99%

Treatment of Closed Tibia Shaft Fractures in Children: A Systematic Review and Meta-Analysis

Stenroos

Puhakka

Nietosvaara³

et al. 2019

Eur J Pediatr Surg

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Tibia fractures are among the most common long-bone fractures in children. Despite this, there is no current consensus on the optimal treatment strategy for closed displaced tibia shaft fractures in the pediatric patient population. The aim of this study is to compare the reported complications and outcomes of reduction and cast immobilization versus flexible intramedullary nailing in the treatment of pediatric tibia shaft fractures. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement when conducting and reporting this prospectively registered systematic review. Eleven studies were included. Quality of the studies was assessed using the Coleman methodology score. Mantel–Haenszel cumulative odds ratios were used to compare the risk of complication between different methods of treatment. Eleven studies including 1,083 patients with diaphyseal fractures of the tibia met the inclusion criteria. The most common fracture type was simple 42-A (782; 91%). Majority (75%) of the patients were treated nonoperatively. The total complication rate was higher among operatively treated patients (24 vs. 9%; p < 0.05). Satisfactory fracture alignment had to be restored surgically in 5% of the primarily nonoperatively treated patients. The evidence levels of the included studies were II (1), III (2), and IV (7). Three-fourths of closed diaphyseal fractures of the tibia in children are still treated with reduction and cast immobilization. Flexible intramedullary nailing is associated with significantly higher complication rate than nonoperative treatment.

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“… 21 Soft-tissue irritation has been reported as a complication of FNs in multiple studies, with incidence ranging from < 10% to as high as 52% 22 but is minor in most cases and relieved with implant removal. 8 , 21 , 23 – 25 Proposed risk factors for irritation include bent or prominent nail ends, 22 earlier mobilization of the knee 12 and excessive nail protrusion at the time of implantation. Accordingly, studies have advocated immobilization, 23 leaving < 2.5 cm of nail protrusion, and minimizing bending the ends of the nails outside the bony cortex during insertion and trimming of the nails to help decrease soft-tissue irritation.…”

Section: Discussionmentioning

confidence: 99%

Submuscular plates versus flexible nails in preadolescent diaphyseal femur fractures

Chen

Sullivan

Sponseller

2018

Journal of Children's Orthopaedics

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Abstract:PurposeTo compare patient characteristics, operative time, estimated blood loss (EBL), postoperative length of hospital stay (LOS) and complications after insertion and removal of submuscular plates (SMPs) versus flexible nails (FNs) for paediatric diaphyseal femur fractures.MethodsWe reviewed records of 58 children (mean age, 7.7 years SD 2.0) with diaphyseal femur fractures who underwent treatment with SMPs (n = 30) or FNs (n = 28) from 2005 to 2017 (mean follow-up, 22 months SD 28). Patients with pathological fractures or musculoskeletal comorbidities were excluded. Alpha = 0.05.ResultsInsertion of FNs was associated with shorter operative time (ß = –24 mins) and less EBL (ß = –38 mL) (both, p < 0.001) compared with insertion of SMPs, after adjusting for fracture type and time from beginning of study period. Removal of FNs was also associated with shorter operative time (ß = –15 min) compared with removal of SMPs (p < 0.001). EBL during removal was similar between groups (p = 0.080). The FN group had a shorter LOS after insertion (ß = –0.2 d) compared with the SMP group (p = 0.032). Four patients treated with SMPs and three treated with FNs developed surgical site infections. Two patients treated with SMPs and seven treated with FNs experienced implant irritation that resolved with removal. No other complications occurred.ConclusionCompared with SMPs, FNs were associated with shorter operative time (for insertion and removal), less EBL (for insertion) and shorter post-insertion LOS in patients with diaphyseal femur fractures.Level of Evidence:III

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Complications of Elastic Stable Intramedullary Nailing for treating paediatric long bone fractures

Cited by 46 publications

References 35 publications

Intramedullary nailing of forearm shaft fractures by biodegradable compared with titanium nails: Results of a prospective randomized trial in children with at least two years of follow-up

Intramedullary nailing of forearm shaft fractures by biodegradable compared with titanium nails: Results of a prospective randomized trial in children with at least two years of follow-up

Treatment of Closed Tibia Shaft Fractures in Children: A Systematic Review and Meta-Analysis

Submuscular plates versus flexible nails in preadolescent diaphyseal femur fractures

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