Rotational Control of Various Pediatric Femur Fractures Stabilized With Titanium Elastic Intramedullary Nails

Gwyn, David T.; Olney, Brad W.; Dart, Bradley; Czuwala, Peter J.

doi:10.1097/01241398-200403000-00007

Cited by 40 publications

(18 citation statements)

References 12 publications

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“…Few reports of further biomechanical testing of the ESIN-osteosynthesis could be found; most of these where not standardized, depicted a small number of cases [35,36], evaluated only a few selected planes [35,37,38] or studied exclusively transverse and oblique fractures [36]. Benz and co-workers investigated changes of stability during 4-point-bending and torsion, but they only achieved sufficient 2-nail flexible intramedullary fixation for testing in 3 out of 10 canine bones [39].…”

Section: Discussionmentioning

confidence: 99%

Modification of elastic stable intramedullary nailing with a 3rd nail in a femoral spiral fracture model – results of biomechanical testing and a prospective clinical study

Kaiser

Stratmann

Zachert

et al. 2014

BMC Musculoskelet Disord

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BackgroundElastic stable intramedullary nailing (ESIN) is the standard treatment for displaced diaphyseal femoral fractures in children. However, high complication rates (10-50%) are reported in complex fractures. This biomechanical study compares the stiffness with a 3rd nail implanted to that in the classical 2C-shaped configuration and presents the application into clinical practice.MethodsFor each of the 3 configurations of ESIN-osteosynthesis with titanium nails eight composite femoral grafts (Sawbones®) with an identical spiral fracture were used: 2C configuration (2C-shaped nails, 2 × 3.5 mm), 3CM configuration (3rd nail from medial) and 3CL configuration (3rd nail from lateral). Each group underwent biomechanical testing in 4-point bending, internal/external rotation and axial compression.Results2C and 3CM configurations showed no significant differences in this spiroid type fracture model. 3CL had a significantly higher stiffness during anterior-posterior bending, internal rotation and 9° compression than 2C, and was stiffer in the lateral-medial direction than 3CM. The 3CL was less stable during p-a bending and external rotation than both the others. As biomechanical testing showed a higher stability for the 3CL configuration in two (a-p corresponding to recurvation and 9° compression to shortening) of three directions associated with the most important clinical problems, we added a 3rd nail in ESIN-osteosynthesis for femoral fractures. 11 boys and 6 girls (2.5-15 years) were treated with modified ESIN of whom 12 were ‘3CL’; due to the individual character of the fractures 4 patients were treated with ‘3CM’ (third nail from medial) and as an exception 1 adolescent with 4 nails and one boy with plate osteosynthesis. No additional stabilizations or re-operations were necessary. All patients achieved full points in the Harris-Score at follow-up; no limb length discrepancy occurred.ConclusionThe 3CL configuration provided a significantly higher stiffness than 2C and 3CM configurations in this biomechanical model. These results were successfully transmitted into clinical practice. All children, treated by 3CL or 3CM according to the individual character of each fracture, needed no additional stabilization and had no Re-Do operations. As a consequence, at our hospital all children with femoral diaphyseal fractures with open physis are treated with this modified ESIN-technique.

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Section: Discussionmentioning

confidence: 99%

Modification of elastic stable intramedullary nailing with a 3rd nail in a femoral spiral fracture model – results of biomechanical testing and a prospective clinical study

Kaiser

Stratmann

Zachert

et al. 2014

BMC Musculoskelet Disord

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“…The biomechanical properties of retrograde C-shaped flexible intramedullary nailing have been described in the literature [39-46]. Most of the authors studied oblique or transverse fractures; only two studies examined the spiral type fracture [45,46]. More or less comparable data of biomechanical testing is thereby only available in these studies.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical analysis of a synthetic femoral spiral fracture model: Do end caps improve retrograde flexible intramedullary nail fixation?

Kaiser

Zachert

Wendlandt

et al. 2011

Journal of Orthopaedic Surgery and Research

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BackgroundElastic Stable intramedullary Nailing (ESIN) of dislocated diaphyseal femur fractures has become an accepted method for the treatment in children and adolescents with open physis. Studies focused on complications of this technique showed problems regarding stability, usually in complex fracture types such as spiral fractures and in older children weighing > 40 kg. Biomechanical in vitro testing was performed to evaluate the stability of simulated spiral femoral fractures after retrograde flexible titanium intramedullary nail fixation with and without End caps.MethodsEight synthetic adolescent-size femoral bone models (Sawbones® with a medullar canal of 10 mm and a spiral fracture of 100 mm length identically sawn by the manufacturer) were used for each group. Both groups underwent retrograde fixation with two 3.5 mm Titanium C-shaped nails inserted from medial and lateral entry portals. In the End Cap group the ends of the nails of the eight specimens were covered with End Caps (Synthes Company, Oberdorf, Switzerland) at the distal entry.ResultsBeside posterior-anterior stress (4.11 Nm/mm vs. 1.78 Nm/mm, p < 0.001), the use of End Caps demonstrated no higher stability in 4-point bending compared to the group without End Caps (anterior-posterior bending 0.27 Nm/mm vs. 0.77 Nm/mm, p < 0.001; medial-lateral bending 0.8 Nm/mm vs. 1.10 Nm/mm, p < 0.01; lateral-medial bending 0.53 Nm/mm vs. 0.86 Nm/mm, p < 0.001) as well as during internal rotation (0.11 Nm/° vs. 0.14 Nm/°, p < 0.05). During compression in 9°- position and external rotation there was no statistical significant difference (0.37 Nm/° vs. 0.32 Nm/°, p = 0.13 and 1.29 mm vs. 2.18 mm, p = 0.20, respectively) compared to the "classic" 2-C-shaped osteosynthesis without End Caps.ConclusionIn this biomechanical study the use of End Caps did not improve the stability of the intramedullary flexible nail osteosynthesis.

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“…TEN is widely accepted as the most reliable and valid method for treating paediatric long bone fractures (29)(30)(31)(32)(33). TEN is able to maintain biomechanical stability owing to the divergent 'C' configuration, which generates six points of fixation and permits the construct to act as an internal splint (34).…”

Section: Head-shaft Angle Of the Fifth Metacarpal -------------------mentioning

confidence: 99%

Outcome of antegrade intramedullary fixation for juvenile fifth metacarpal neck fracture with titanium elastic nail

Shen

Cao

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The purpose of the current study was to assess the outcome of antegrade intramedullary fixation with titanium elastic nail (TEN) in displaced fifth metacarpal neck fractures. The present study included 69 consecutive juvenile patients with displaced fifth metacarpal fractures. The head-shaft angle of the fifth metacarpal and range of motion (ROM) of the metacarpophalangeal (MCP) joint were evaluated. A disabilities of the arm, shoulder and hand (DASH) questionnaire was used to assess upper arm function. The head-shaft angle of the affected side was significantly improved postoperatively (P<0.05). No marked difference was observed between the affected and unaffected side in head-shaft angle and ROM. The average DASH score was 1.7 (range, 0-6.0). All patients obtained anatomical reduction postoperatively and the average healing time was 5.7±1.09 weeks (range, 5-10 weeks) with no non-union cases. Therefore antegrade intramedullary fixation with TEN is recommended as an easy, reliable and minimally invasive surgical technique for treating displaced fifth metacarpal neck fractures.

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Rotational Control of Various Pediatric Femur Fractures Stabilized With Titanium Elastic Intramedullary Nails

Cited by 40 publications

References 12 publications

Modification of elastic stable intramedullary nailing with a 3rd nail in a femoral spiral fracture model – results of biomechanical testing and a prospective clinical study

Modification of elastic stable intramedullary nailing with a 3rd nail in a femoral spiral fracture model – results of biomechanical testing and a prospective clinical study

Biomechanical analysis of a synthetic femoral spiral fracture model: Do end caps improve retrograde flexible intramedullary nail fixation?

Outcome of antegrade intramedullary fixation for juvenile fifth metacarpal neck fracture with titanium elastic nail

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