Use and Abuse of Flexible Intramedullary Nailing in Children and Adolescents

Lascombes, P.; Haumont, T.; Journeau, Pierre

doi:10.1097/01.bpo.0000235397.64783.d6

Cited by 259 publications

(214 citation statements)

References 22 publications

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“…In essence, the results of this study implicate that repeated and closed passes of IM fixation devices (i.e., flexible nails) can create soft tissue damage and swelling, creating a favorable environment for the development of CS. This is a recognized iatrogenic risk seen with this technique [12].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, flexible intramedullary nailing has become the preferred method for the treatment of tibial shaft fractures that require operative fixation [6,[8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…Efficacy of this technique is augmented when utilizing implants that encompass 80% of the diameter of the medullary canal at its narrowest point [12]. The advantages of this technique include stability, flexible mobility, and the ability to perform a closed reduction with minimal disruption of the soft tissue and periosteal blood supply.…”

Section: Introductionmentioning

confidence: 99%

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The incidence of compartment syndrome after flexible nailing of pediatric tibial shaft fractures

Pandya¹,

Edmonds

Mubarak

2011

Journal of Children's Orthopaedics

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Purpose Pediatric tibial shaft fractures are common injuries encountered by the orthopaedic surgeon. Flexible intramedullary nailing has become popular for pediatric patients with tibial shaft fractures that require operative fixation. The purpose of our study was to evaluate the incidence of, and the risk factors for, compartment syndrome (CS) after flexible intramedullary nailing of these injuries. Methods A retrospective review of tibial shaft fractures treated consecutively with flexible intramedullary nailing at our institution from 2003 to 2010 was performed. The incidence of CS after flexible nailing was recorded. In addition, age, weight, mechanism of injury, polytrauma, presence of an open fracture, presenting neurovascular exam, fracture pattern, delay in treatment ([24 h from injury), prior closed reduction attempts, method of reduction (open vs. closed) in the operating room, total fluoroscopy time, and operative time were recorded. Comparisons were made between children who developed CS and those who did not. Results Thirty-one children met inclusion criteria with a mean age of 11.2 years (range, 6.3-15.3 years); all were boys. Nearly, 20% of children developed CS after flexible nailing of their fractures. Those who developed CS after flexible nailing were heavier than the unaffected group (52.6 ± 14.5 kg vs. 39.4 ± 15.2 kg, P = 0.05); with a greater percentage of children 50 kg or greater (83.3% vs. 26.1%, P = 0.02) within the CS group. Children who developed CS were also more likely to present with neurologic deficits in the absence of compartmental swelling prior to surgery (66.7% vs. 9.1%, P = 0.009), and more likely to have comminuted/complex fracture patterns (83.3% vs. 29.1%, P = 0.02). There was no difference between patients who did and did not develop CS in regards to age (P = 0.42), high-energy injury mechanism (P = 0.30), polytrauma (P = 1.0), delay in treatment (P = 0.28), prior closed reduction attempts (P = 1.0), method of reduction (open vs. closed; P = 1.0) in the operating room, total fluoroscopy time (P = 0.96), and total operative time (P = 0.45). In addition, there was no difference (P = 0.65) in the rates of CS between children with open and closed fractures. Conclusions There is a high risk of CS after flexible intramedullary nailing of pediatric tibial shaft fractures regardless of whether an injury is open or closed. Variables that would seemingly be associated with the development of CS (high-energy injury mechanisms, polytrauma, treatment delay, prior closed reduction attempts, and closed reduction in the operating room) were not statistically associated with CS in our study. Clinicians should be wary for the development of CS whenever utilizing flexible nails for tibial shaft fractures, especially when the following co-morbidities are present: the child weighs greater than 50 kg, has complex/comminuted fracture patterns, or has a neurologic deficit in the absence of compartmental swelling prior to operative intervention.

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Section: Discussionmentioning

confidence: 99%

“…Recently, flexible intramedullary nailing has become the preferred method for the treatment of tibial shaft fractures that require operative fixation [6,[8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The incidence of compartment syndrome after flexible nailing of pediatric tibial shaft fractures

Pandya¹,

Edmonds

Mubarak

2011

Journal of Children's Orthopaedics

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“…In addition, psychological recovery is accelerated by early resumption of functional activity, allowing for a rapid return to school and ordinary family life (11)(12)(13)(14). Despite the various advantages of TEn, however, complication rates of up to 60% have been reported, due mostly to incorrect operative techniques and poor patient selection (15)(16)(17)(18)(19)(20)(21)(22). The most common reported complication is soft-tissue irritation at the TEn entry side (15)(16)(17)(18)(19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

Pitfalls of femoral Titanium Elastic Nailing

et al. 2014

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Background and Aims: Despite several potential complications of elastic intramedullary nailing, it is currently the treatment of choice for femoral diaphyseal fractures in schoolaged children. this study aimed to critically evaluate the complications of titanium elastic nailing in pediatric femoral shaft fractures.Material and Methods: this study evaluated patients with a diaphyseal femoral fracture treated with titanium elastic nailing (ten) in tampere university Hospital in finland. the study group included 32 children with a mean age of 9 years during a 5-year period, from 1 January 2003 to 31 December 2007. Data were collected from medical records and x-rays. mean follow-up time was 42 months.Results: of 32 patients, 9 (28%) reported a postoperative complication. complications were associated with nail prominence in five (16%) patients and instability in four (12%) patients. in patients with nail prominence, the titanium elastic nailing-nail ends were unbent and 10-35 mm outside the cortex of the distal femur. the nail prominence caused pain and delayed knee mobilization until the nail was removed after a mean time of 4 months. in patients with fracture instability, the mean titanium elastic nailing-nail/ medullary canal diameter ratio was 46% and periosteal callus formation was 5.4 mm at the first control. in those with stable fractures, the values were 66% and 9.2 mm, respectively.Conclusions: based on this study, two types of pitfalls in a small volume center were found. titanium elastic nail ends were left unbent and too long. We recommend palpating the nail ends to exclude nail prominence and to verify free movement of the knee after nail cutting and bending. fracture instability was caused by inserting titanium elastic

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“…Flexible intramedullary nailing has become an accepted treatment for pediatric femur fractures [1][2][3][4][5][6]. Complications of nailing have been described as occurring in up to 62% of cases [7].…”

Section: Introductionmentioning

confidence: 99%

Proximal femoral neck penetration after flexible intramedullary nailing for pediatric femur fractures: A rare complication

Carmichael

Schroeder

2007

Journal of Children's Orthopaedics

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Flexible intramedullary nailing is a common method used to treat pediatric femur fractures. Complication rates can be high, but most complications are considered minor and do not result in additional unplanned surgeries. Proximal nail penetration is a complication that has only been described once before. The penetration may be asymptomatic, but is still best to be avoided. Two cases of proximal nail penetration of the femoral neck region during nail insertion are presented. A review of the literature with regard to complications and suggestions for avoidance of proximal nail penetration is offered.

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Use and Abuse of Flexible Intramedullary Nailing in Children and Adolescents

Abstract: The good results of this reliable technique are obtained when surgeons have a good knowledge of it, especially in the understanding of the principle of the correction of the fracture and its stability.

Cited by 259 publications

References 22 publications

The incidence of compartment syndrome after flexible nailing of pediatric tibial shaft fractures

The incidence of compartment syndrome after flexible nailing of pediatric tibial shaft fractures

Pitfalls of femoral Titanium Elastic Nailing

Proximal femoral neck penetration after flexible intramedullary nailing for pediatric femur fractures: A rare complication

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