Titanium elastic nailing versus locking compression plating in school-aged pediatric subtrochanteric femur fractures

Abstract

The treatment of children between 5 and 12 years of age suffering from subtrochanteric femoral fracture is challenging. The optimal choice of internal fixation for these patients is controversial. The purpose of this study is to compare the outcomes and complications of titanium elastic nail and open reduction with plate fixation of subtrochanteric femur fractures in school-aged children.A total of 67 children aged 5 to 12 years with subtrochanteric femur fractures treated with titanium elastic nails or open plating were identified at our institution from January 2007 to December 2017. We retrospectively compared 39 children treated with titanium elastic nails with 28 children treated with open reduction and plate fixation. The data included age, sex, body weight, fracture pattern, operation time, blood loss, and length of hospitalization. The follow-up investigations included radiograph of pelvis, bilateral hip range of motion, bilateral femoral neck shaft angle, and length of lower extremity. The outcomes were classified according to Flynn classification as excellent, satisfactory, or poor. All the demographic characteristics were compared with statistical analyses.All 67 fractures united properly. No major postoperative complications were noted in both groups. No significant difference was found between the titanium elastic nail and open plating groups in terms of sex, fracture pattern, and length of hospitalization. We noted a significant difference between 2 groups in terms of age, weight, operation time, and blood loss. In total, we observed 24 excellent and 15 satisfactory results in the titanium elastic nail group, and 19 excellent results and 9 satisfactory results in the open plating group. There was no significant statistical difference between involved and uninvolved side of hip regarding range of motion and femoral neck shaft angle in both groups.Titanium elastic nail and pediatric hip plate fixation represent safe and effective methods in the treatment of subtrochanteric fractures in school-aged children. Titanium elastic nail internal fixation is a minimal invasive and simpler technique and suitable for young children of lower body weight. Open plate fixation is a more rigid fixation associated with a lower complication rate.

Outcome of proximal femur shaft fractures in school going children treated with locking compression plates

“…Xu X et al 17 noted excellent outcome in 87% children while Wu QZ et al 18 reported excellent results in 76.9%, good in 15.3% and fair in 7.6% children. Some authors 19 are of the opinion that although plating is a rigid form of fixation it has minimal complications and produced excellent results in 67.8% and satisfactory in 32.1% children. In our study all the children achieved complete radiological union in 13.3±1.2 weeks (range 9.4 to 18 weeks).…”

Hastes intramedulares flexíveis para fixação de fraturas subtrocantéricas de fêmur simuladas em modelos pediátricos: avaliação da estabilidade mecânica e método dos elementos finitos

“…Such results seem to be supported by some clinical evidence [14]. However, when the fracture is situated at proximal metaphysis the use of FINs is controversial [15,16,17].…”

“…Assim, Pombo e Shilt ( 2006) definiram fratura subtrocantérica como aquela localizada até o limite de 10% do comprimento total do fêmur, distalmente ao trocanter menor (POMBO; . O método em evidência, também usado por outros autores (XU et al, 2018;LI et al, 2013), foi adotado no presente estudo.…”

“…É válido mencionar, entretanto, que nesse trabalho o número de casos foi pequeno e houve necessidade de restringir a mobilidade pós-operatória. Desta forma, a fixação com hastes é técnica menos invasiva e adequada para crianças de menor peso corporal, enquanto que a placa infantil bloqueada é fixação mais rígida e está associada à menor taxa de complicações como perda da redução (XU et al, 2018;REDDY et al, 2018).…”

“…Estudos tentam avançar e estabelecer a indicação precisa para a utilização das hastes intramedulares flexíveis nas fraturas localizadas na região proximal do fêmur, entretanto esse tema ainda permanece controvertido na literatura (LI et al, 2013;MOROZ et al, 2006;PARIKH et al, 2014;XU et al, 2018).…”