Titanium elastic nailing in diaphyseal femoral fractures of children below six years of age

Abstract

AIMTo report the clinical and radiographic results of titanium elastic nail (TEN) in diaphyseal femoral fractures of children below age of six years.METHODSA retrospective analysis of 27 diaphyseal femoral fractures in children younger than six years treated with TEN between 2005 and 2015 was conducted. Patients were immobilized in a cast for 5 wk and the nails were removed from 6 to 12 wk after surgery. Twenty-four cases were clinically and radiographically re-evaluated using the Flynn’s scoring criteria, focusing on: Limb length discrepancy, rotational deformity, angulation, hip and knee range of motion (ROM), functional status, complications, and parent’s satisfaction.RESULTSSixteen males and eight females with a mean age of 3.2 years at the time of treatment were re-evaluated at an average follow-up of 58.9 mo. No cases of delayed union were observed. The mean limb lengthening was 0.3 cm. Four cases experienced limb lengthening greater than 1 cm and always minor than 2 cm. Twelve point five percent of the cases showed an angulation < 10°. Complete functional recovery (hip and knee ROM, ability to run and jump on the operated limb) occurred in 95.7% of cases. Complications included two cases of superficial infection of the TEN entry point, one case of refracture following a new trauma, and one TEN mobilization. According to the Flynn’s scoring criteria, excellent results were obtained in 79.2% of patients and satisfactory results in the remaining 20.8%, with an average parent’s satisfaction level of 9.1/10.CONCLUSIONTEN is as a safe, mini-invasive and surgeon-friendly technique and, considering specific inclusion criteria, it represents a useful and efficacy option for the treatment of diaphyseal femoral fractures even in patients younger than six years of age.

Treatment of closed femoral shaft fractures in children aged 2–10 years: a systematic review and meta-analysis

“…Other complications for spica casting Nascimento [20] n = 30 3 (10%) 1 (3.3%) 2 (6.7%) Shemshaki [16] n = 23 3 (13%) 0 (0%) 3 (13%) Hsu [18] n = 25 2 (8%) 2 (8%) 0 (0%) Mehdinasab [15] n = 30 7 (23.3%) 4 (13.3%) 3 (10%) Flynn [19] n = 35 12 (34%) 6 (17%) 6 (17%) Song [21] n = 24 2 (8,3%) 2 (8.3%) 0 (0%) Buechsensuetz [22] n = 29 10 (34%) 10 (34%) 3 (10%) Younis et al [28] n = 20 4 (16.6%) 4 (16.6%) 0 (0%) D'Ollonne [26] n = 14 3 (21.4%) 2 (14.3%) 1 (7.1%) Yandow [27] n = 55 5 (9.1%) 3 (5.5%) 2 (3.6%) Curtis [24] n = 21 10 (48%) 8 (38%) 2 (10%) Henderson [25] n Nascimento [20] n = 30 3 (10%) 2 (6.7%) 1 (3.3%) Shemshaki [16] n = 23 3 (13%) 0 (0%) 3 (13%) Hsu [18] n = 26 3 (11.5%) 3 (11.5%) 0 (0%) Mehdinasab [15] n = 36 6 (16.7%) 6 (16.7%) 0 (0%) Flynn [19] n = 48 10 (21%) 6 (12.5%) 4 (8.3%) Song [21] n = 27 4 (14.8%) 1 (3.7%) 3 (11.1%) Buechsensuetz [22] n = 42 9 (22%) 7 (17%) 2 (5%) Ramo [13] n = 104 17 (16.3%) 9 (8.7%) 8 (7.7%) Ruhallah [7] n = 25 2 (8%) 2 (8%) 0 (0%) Assaghir [11] n = 52 10 (19%) 9 (17%) 1 (2%) Jauquier [9] n = 27 3 (11%) 2 (7.4%) [7] n = 25 4 (17%) 4 (17%) 0 (0%) Assaghir [11] n = 52 20 (38%) 20 (38%) 0 (0%) Jauquier [9] n = 19 2 (10.5%) 2 (10.5%) 0 (0%) Younis et al 2019 [28] n = 24 6 (30%) 6 (30%) 0 (0%) D'Ollonne [26] n = 21 3 (14.3%) 3 (14.3%) 0 (0%) Yandow [27] n = 33 1 (3.0%) 1 (3%) 0 (0%) Curtis [24] n include compartment syndrome and superior mesenteric artery syndrome [34,35]. Intramedullary nailing comes with general risks related to anesthesia and surgery risks like wound infection [7,16,3...…”

Effect of titanium elastic nailing surgery on the femoral development in pediatric femoral fractures

“…Based on their study involving the findings of 30 pediatric patients (their age ranged from 6 to 15 years old) with femoral diaphyseal fractures, Kayaokay et al 12 highlighted that TEN surgery is an effective and easy surgery along with minimal complication. Similarly, in another study on 27 children under the age of 6 who were treated with TEN surgery following the femoral fractures, Donati et al 1 reported that the TEN surgery is safe, mini-invasive, and has high patient satisfaction. In accordance with the previous studies, fracture union occurred in all the patients (6 of them were under 6 years old and 29 of them were between 6 and 15 years old) in our study.…”

“…While nonoperative treatment had been the most common choice in the past, pediatric orthopedic surgeons have avoided long-term immobilization in the last 20 years because of the disadvantages such as malunion, limited range of motion, delayed functional return, and long-term hospitalization [7][8][9] . Since titanium elastic nailing surgery allows early mobilization, allows micromotion hence promote fracture healing, does not harm the epiphysis, and has the advantages of easy application, this surgery has become the ideal treatment in the surgical treatment of closed pediatric femoral shaft fractures of all ages 1,10,11 . Based on their study involving the findings of 30 pediatric patients (their age ranged from 6 to 15 years old) with femoral diaphyseal fractures, Kayaokay et al 12 highlighted that TEN surgery is an effective and easy surgery along with minimal complication.…”

“…The treatment of femoral shaft fractures for pediatric patients has been controversial 1,2 . In classical text books, titanium elastic nailing (TEN) surgery is highly recommended in almost all pediatric patients between the ages of 5 and 10 years old whereas a conservative treatment between 6 months and 5 years results in failure 3 .…”

The titanium elastic nail serves as an alternative treatment for adult proximal radial shaft fractures: a cohort study

“…Because of the 3-point pressure on the bone, the pre-bent bow shape of the TEN is less likely to back out. In our cohort, the rotational force was resisted with postoperative long arm cast over 4 weeks at the forearm supination position for radial paralleling the ulna, and pre-bent TENs are designed in a hockey stick shape with the nail tip inserted into the radial head for rotational stability [ 15 , 16 ].…”