Early complications with flexible intramedullary nailing in childhood fracture: 100 cases managed with precurved tip and shaft nails

Lascombes, P.; Nespola, A.; Poircuitte, Jean-Manuel; Popkov, Dmitry; Gheldere, Antoine de; Haumont, T.; Journeau, Pierre

doi:10.1016/j.otsr.2011.11.011

Cited by 55 publications

(40 citation statements)

References 39 publications

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“…Our TEN group was too small to arrive at any firm conclusions, and our sole significant side effect of the TEN treatments was soft tissue irritation at the insertion site in one patient. The literature, however, more fully describes complications associated with TEN, such as re-fractures, delayed unions, varus or valgus malalignments, malrotation, nail tip irritations, broken interlocking screws, and proximal nail migration, reaching an overall complication rate of 11.7% [19-22]. …”

Section: Discussionmentioning

confidence: 99%

Pediatric femoral shaft fractures: treatment strategies according to age - 13 years of experience in one medical center

et al. 2013

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ObjectiveThe objective of this study was to analyze our experience in treating femoral shaft fractures with different strategies, focusing on the first year after injury when the choice of method would have the greatest impact.MethodsWe reviewed the medical records of all children treated for femoral shaft fractures in our institution between 1997 and 2010. They were divided according to therapeutic approach: spica cast, skin traction, titanium elastic nail (TEN), external fixator, intramedullary medullary nail (IMN), and plating.ResultsThe 212 patients included 150 boys and 62 girls (M/F ratio 2.4:1, mean age 5 years, range 0–16). The postoperative radiographic results demonstrated solid union in all patients, with no malunions. Of the 151 children in the spica cast group, 10 required re-manipulation and casting due to loss of reduction with unaccepted angulation, 10 had contact dermatitis, and 2 had fever and pressure sores. All 21 elastic nail group children underwent re-operation to remove the hardware: 3 had soft tissue irritation at the insertion points, and 3 had leg length discrepancy (LLD). Of the 14 external fixation patients, 4 had LLD, 1 had a pin tract infection, and 1 had a fracture through a pinhole after a fall. There were no complications in the 12 IMN patients, the 3 plating patients, or the 11 skin traction patients. LLD rates in the spica group were 10.5% higher compared to those in the control group (other treatment modalities) (P = .03).ConclusionsTEN treatment was superior to spica casting for children who had reached an average age of 4 years.

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Section: Discussionmentioning

confidence: 99%

Pediatric femoral shaft fractures: treatment strategies according to age - 13 years of experience in one medical center

et al. 2013

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“…The advantages are minimally invasive surgery with a short hospitalization duration, primary bone union and early weight bearing. [1–4] ESIN can be considered the “gold standard” for the treatment of midshaft fractures, but there are concerns about their use in distal tibial diaphyseal and proximal metaphyseal fractures, its proximity to the ankle makes the surgical technique more complicated than the treatment of the midshaft fractures, and the stability supplied by the nails cannot be achieved optimally.…”

Section: Introductionmentioning

confidence: 99%

Elastic stable intramedullary nailing for severely displaced distal tibial fractures in children

Shen

Cai²,

Wang³

et al. 2016

Medicine

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Elastic stable intramedullary nailing (ESIN) has became a well-accepted method of osteosynthesis of diaphyseal fractures in the skeletally immature patient for many advantages, the purpose of this study is to evaluate the preliminary results of this minimally invasive treatment for severely displaced distal tibial diaphyseal metaphyseal junction (DTDMJ) fractures.This study was carried out over a 6-year period. Twenty-one severely displaced DTDMJ fractures treated using ESIN were evaluated clinically and radiographically. Complications were assessed: the patients were evaluated with regard to nonunion, malunion, infection, growth arrest, leg length discrepancy, implant irritation, and joint function.Mean age at the time of surgery was 7.8 years (range between 5.3 and 14.8 years), mean body weight 34.1 kg, all fractures were transverse or mild oblique type, including 3 open fractures, 5 multifragmented fractures, and 4 fractures associated with polytrauma; 6 cases were treated with antegrade ESIN of tibia while 15 cases need combined retrograde fibula and antegrade tibia fixation treatments. Follow-ups were ranging from 11 to 36 months, 19 fractures showed both clinical and radiographic evidence of healing within 5 months; all cases had full range motion of knee and ankle with symmetrical foot progress angle. Nail removal was at a mean 7.1 months, at final follow-up, no growth arrest or disturbances occurred. Five patients had complications; leg length discrepancy had decreased yet affected 2 patients, 2 cases showed delayed union, and 1 case developed restricted dorsal extension at the metatarsophalangeal joint of the hallux.ESIN is the treatment of choice for pediatric severely displaced DTDMJ fractures that cannot be reduced by closed reduction or ones that cannot be casted. The advantages include faster fracture healing, excellent functional and cosmetic results, safe and reliable surgical technique, and lower severe complication rate.

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“…TENs ranging in thickness from 2 to 4 mm could be used as an alternative [14,15], but in femurs diffusely affected by fibrous dysplasia, the absence of the medullary canal and the presence of a very thin cortex can make application of TENs very difficult owing to the likelihood of perforation. Moreover, TENs do not provide an internal stabilization strong enough to protect dysplastic bone against subsequent fractures and/or deformities [1].…”

Section: Discussionmentioning

confidence: 99%

Internal fixation after fracture or osteotomy of the femur in young children with polyostotic fibrous dysplasia

Valentini

Ippolito

Catellani

et al. 2015

Journal of Pediatric Orthopaedics B

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Children from 4 to 7 years of age with polyostotic fibrous dysplasia (PFD) may need internal fixation of the femur for either fracture or osteotomy. At that age, the small size of the femur allows only the use of small intramedullary nails. However, titanium elastic nails and rigid intramedullary pediatric interlocking femoral nails - good for fracture or osteotomy fixation in the normal femur - are not indicated in PFD. From 2009 to 2011, we treated eight cases of PFD femoral fracture and deformity by internal fixation with a custom-modified adult humeral nail to which a spiral blade was connected. The 7-mm thick nail fit properly into the small femoral shaft and the spiral blade conferred ideal mechanical support to the femoral neck. Three cases had replacement of the humeral nail with a more appropriate adult femoral nail 3 years after the index procedure when the femur had reached an adequate size. In the maximum follow-up period of 4 years, few complications were observed.

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Early complications with flexible intramedullary nailing in childhood fracture: 100 cases managed with precurved tip and shaft nails

Abstract: Level IV. Retrospective study.

Cited by 55 publications

References 39 publications

Pediatric femoral shaft fractures: treatment strategies according to age - 13 years of experience in one medical center

Pediatric femoral shaft fractures: treatment strategies according to age - 13 years of experience in one medical center

Elastic stable intramedullary nailing for severely displaced distal tibial fractures in children

Internal fixation after fracture or osteotomy of the femur in young children with polyostotic fibrous dysplasia

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