Unstable Femoral Fractures Treated With Titanium Elastic Intramedullary Nails, in Children

Soni, Jamil Faissal; Schelle, Gisele Cristine; Valenza, Weverley Rubele; Pavelec, Anna Carolina; Souza, Camila Deneka Arantes

doi:10.1016/s2255-4971(15)30006-9

Cited by 6 publications

(8 citation statements)

References 26 publications

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“…Mesmo sendo resultados preliminares, os autores se mostraram otimistas com o tratamento operatório que evoluiu para consolidação e recuperação funcional sem grandes complicações. Em 2012, Soni, 39 ao avaliar retrospectivamente 24 fraturas diafisárias de fêmur pediátricas, sugeriu que as hastes intramedulares elásticas de titânio estão relacionadas a bons resultados em fraturas instáveis.…”

Section: Dados Da Literaturaunclassified

“…Even though these are preliminary results, the authors are optimistic about the surgical treatment that progresses to consolidation and functional recovery without major complications. In 2012, Soni, 39 when retrospectively evaluating 24 pediatric femur diaphyseal fractures, suggested that titanium elastic intramedullary rods are related to good results in unstable fractures.…”

Section: Literature Datamentioning

confidence: 99%

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Fraturas na criança: Estamos ficando mais cirúrgicos?

Cunha

Pontes

2022

Rev Bras Ortop (Sao Paulo)

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ResumoHistoricamente, as cirurgias no esqueleto imaturo eram reservadas às fraturas expostas ou articulares. Nos últimos anos, a melhora na qualidade e segurança das anestesias, novos equipamentos de imagem, implantes desenhados especialmente para fraturas pediátricas, associados à possibilidade de menor tempo de hospitalização e rápido retorno ao convívio social vêm demonstrando uma nova tendência de avaliar e tratar fraturas na criança. O objetivo deste artigo de atualização é responder às seguintes questões: (1) estamos realmente ficando mais cirúrgicos na abordagem das fraturas em crianças? (2) Caso isto seja verdadeiro, esta conduta cirúrgica está baseada em evidências científicas? De fato, nas últimas décadas, a literatura médica demonstra artigos que suportam melhor evolução das fraturas na criança com o tratamento cirúrgico. Nos membros superiores, isto fica muito evidente na sistematização da redução e fixação percutânea das fraturas supracondilianas do úmero e das fraturas de ossos do antebraço. Nos membros inferiores, o mesmo ocorre com fraturas diafisárias do fêmur e tíbia. No entanto, há lacunas na literatura. Os estudos publicados são geralmente com baixa evidência científica. Assim, pode-se deduzir que, mesmo sendo a abordagem cirúrgica mais presente, o tratamento de fraturas pediátricas deve ser sempre individualizado e conduzido de acordo com o conhecimento e experiência do médico profissional, levando em conta a presença de recursos tecnológicos disponíveis para o atendimento do pequeno paciente. Deve-se incluir todas as possibilidades, não cirúrgicas e/ou cirúrgicas, sempre instituindo ações baseadas na ciência e em concordância com os anseios da família.

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Section: Dados Da Literaturaunclassified

Section: Literature Datamentioning

confidence: 99%

Fraturas na criança: Estamos ficando mais cirúrgicos?

Cunha

Pontes

2022

Rev Bras Ortop (Sao Paulo)

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“…This fracture is often associated with > 2 cm of shortening[ 5 , 12 ]. The length unstable diaphyseal femoral fracture is problematic in children ages 5–11 due to the long recovery time, skeletal immaturity, heightened risk of post-operative complications, and a lack of consensus as to the proper fixation modality[ 5 , 6 , 13 ]. Options include external fixation (Ex fix), submuscular plating (SMP), open/compression plating, flexible intramedullary nailing (FIMN) (titanium vs stainless steel) (locked vs non-locked), rigid intramedullary nailing, ex fix in combination with elastic nailing, semi-rigid pediatric locking nail, and others[ 14 - 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although FIMN is an effective procedure for length stable diaphyseal pediatric femoral fractures, there is concern regarding its use for length unstable fractures[ 8 , 9 , 14 , 18 - 21 ]. Potential complications with FIMN treatment for length unstable fractures include suboptimal stability leading to angulation, shortening, rotation[ 8 , 22 - 24 ], and nail protrusion resulting in symptomatic hardware with skin irritation being the primary patient complaint[ 6 , 16 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

Length unstable femoral fractures: A misnomer?

Mussell¹,

Jardaly²,

Gilbert³

2020

WJO

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BACKGROUND Flexible intramedullary nailing (FIMN) is relatively contraindicated for pediatric length unstable femoral fractures. AIM To evaluate FIMN treatment outcomes for pediatric diaphyseal length unstable femoral fractures in patients aged 5 to 13 years. METHODS This retrospective study includes pediatric patients (age range 5-13 years) who received operative treatment for a diaphyseal femoral fracture at a single institution between 2013 and 2019. Length unstable femur fractures treated with FIMN were compared to treatment with other fixation methods [locked intramedullary nailing (IMN), submuscular plating (SMP), and external fixation] and to length stable fractures treated with FIMN. Exclusion criteria included patients who had an underlying predisposition for fractures ( e.g ., pathologic fractures or osteogenesis imperfecta), polytrauma necessitating intensive care unit care and/or extensive management of other injuries, incomplete records, or no follow-up visits. Patients who had a length stable femoral fracture treated with modalities other than FIMN were excluded as well. RESULTS Ninety-five fractures from ninety-two patients were included in the study and consists of three groups. These three groups are length unstable fractures treated with FIMN ( n = 21), length stable fractures treated with FIMN ( n = 45), and length unstable fractures treated with either locked IMN, SMP, or external fixator ( n = 29). P values < 0.05 were considered statistically significant. Patient characteristic differences that were statistically significant between the groups, length unstable with FIMN and length unstable with locked IMN, SMP, or external fixator, were average age (7.4 years vs 9.3 years, respectively), estimated blood loss (29.2 mL vs 98 mL, respectively) and body mass (27.8 kg vs 35.1 kg, respectively). All other patient characteristic differences were statistically insignificant. Regarding complications, length unstable with FIMN had 9 total complications while length unstable with locked IMN, SMP, or external fixator had 10. Grouping these complications into minor or major, length unstable with locked IMN, SMP, or external fixator had 6 major complication while length unstable with FIMN had 0 major complications. This difference in major complications was statistically significant. Lastly, when comparing patient characteristics between the groups, length unstable with FIMN and length stable with FIMN, all characteristics were statistically similar except time to weight bearing (39 d vs 29 d respectively). When analyzing complication differences between these two groups (9 total complications, 0 major vs 20 total complications, 4 major)...

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“…The main indication of ESIN is a transverse or short oblique long bone diaphyseal fracture of the growing skeleton in children between the ages of five and 12 years and weighing less than 50 kg [6]. Due to the simple operative technique and the rapid healing potential of the growing skeleton of the child, surgeons increasingly use this technique even in oblique or comminuted fractures [1,5,7]. 1 2 3…”

Section: Introductionmentioning

confidence: 99%

Leg Length Discrepancy Due to Loss of Femoral Antecurvatum After Elastic Stable Intramedullary Nailing of Diaphyseal Fractures of the Femur in Children

Samelis

Papagrigorakis²,

Troupis

et al. 2019

Cureus

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Limb length discrepancy (LLD) is a frequent complication after elastic stable intramedullary nailing (ESIN) of femoral shaft fractures in children. It is the result of either shortening or lengthening of the affected limb. A shorter limb is usually observed when there is no strict adherence to the main indication of the technique, which is a transverse or short oblique fracture of the diaphysis. A longer limb may be the result of either improper reduction and significant dissociation of fracture fragments, or stimulation of growth of the fractured bone of the child, known as overgrowth. We describe a potential third cause of limb lengthening after treating femoral shaft fractures with the ESIN technique. LLD may be the result of acute femur lengthening due to the loss of normal femoral antecurvatum.

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Unstable Femoral Fractures Treated With Titanium Elastic Intramedullary Nails, in Children

Cited by 6 publications

References 26 publications

Fraturas na criança: Estamos ficando mais cirúrgicos?

Fraturas na criança: Estamos ficando mais cirúrgicos?

Length unstable femoral fractures: A misnomer?

Leg Length Discrepancy Due to Loss of Femoral Antecurvatum After Elastic Stable Intramedullary Nailing of Diaphyseal Fractures of the Femur in Children

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