Flexible intramedullary nails with traction versus plaster cast for treating femoral shaft fractures in children: comparative retrospective study

Abstract

CONTEXT AND OBJECTIVE: Femoral fractures are common in children between 2 and 12 years of age, and 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as conservative treatment. However, in some situations, a surgical approach is recommended. The objective here was to compare treatments for femoral shaft fractures using intramedullary nails (titanium elastic nails, TEN) versus traction and plaster casts in children. The hypothesis was that TEN might provide better treatment, with good clinical results in comparison with plaster casts. DESIGN AND SETTING: This retrospective comparative study was conducted in a public university hospital. METHODS: Sixty children with femoral fractures were evaluated; 30 of them underwent surgical treatment with TEN and 30 were treated conservatively using plaster casts. The patients' ages ranged from 5 to 13 years (mean of 9 years). RESULTS:The mean duration of hospitalization was nine days for the surgical group and 20 days for the conservative group. The incidence of overgrowth in the patients treated with TEN was 60.0% and, for those treated conservatively, 13.3%. Partial weight-bearing was allowed after 3.5 weeks in the surgical group and after 9.6 weeks in the conservative group. New hospitalization was required for 90.0% in the surgical group and 16.7% in the conservative group. Patients treated with plaster casts presented higher incidence of complications, such as loss of reduction. CONCLUSIONS: The surgical method presented better results for children. RESUMO CONTEXTO E OBJETIVO:Fraturas femorais são comuns em crianças entre 2 e 12 anos de idade, e 75% das lesões acometem a diáfise. Tração seguida de aparelho gessado ("gesso") é universalmente aceita como tratamento conservador. Entretanto, em algumas situações o tratamento cirúrgico é recomendado. O objetivo foi comparar o tratamento de fraturas diafisárias do fêmur com hastes intramedulares (titanium elastic nails, TEN) com tração e gesso em crianças. A hipótese era de que TEN pode ser melhor tratamento, com bons resultados clínicos em comparação com o gesso. TIPO DE ESTUDO E LOCAL: Este estudo retrospectivo e comparativo foi conduzido num hospital público universitário. MÉTODOS: Sessenta crianças com fraturas de fêmur foram avaliadas, 30 delas foram submetidas a tratamento cirúrgico com TEN e 30 foram tratadas de forma conservadora usando gesso. A idade dos pacientes variou de 5 a 13 anos (média de 9 anos). RESULTADOS: O tempo médio de internação foi de 9 dias para o grupo cirúrgico e 20 dias para o grupo conservador. A incidência de crescimento excessivo nos pacientes tratados com TEN foi de 60,0% e, para aqueles tratados de forma conservadora, 13,3%. Sustentação parcial de peso foi permitida após 3,5 semanas no grupo cirúrgico e após 9,6 semanas no grupo conservador. Houve 90,0% de novas internações no grupo cirúrgico e 16,7% no grupo conservador. Pacientes tratados com gesso apresentaram maior incidência de complicações, tais como perda de redução. CONCLUS...

The Results of Retrograd Intramedullary Elastic Nailing in the Treatment of Pediatric Femoral Shaft Fractures

“…In Nascimento et al's study 26 that compared titanium elastic intramedullary nailing to pelvipedal casting folllowing traction, they detected lenghtening in 60% of patients (mean 0.66 cm) and shortening in 6.7% of patients (mean 0.25 cm) in the surgery group. However, in the casting group, they reported shortening in 63.3% of patients (mean 1.14 cm) and shortening in 13.3% of patients (mean 1.06 cm).…”

“…7.6 ± 1.5 weeks in Assaghir's series 29 . In Nascimento et al's 26 study that compared results of titanium elastic nailing to pelvipedal casting following traction, mean reunion time was 7.7 weeks in surgery group and 9.3 weeks in conservative treatment group.…”

“…Nascimento et al 26 compared outcomes of intramedullary elastic nailing to pelvipedal casting followed by traction and reported mean time of hospitalization as 9 days in intramedullary nailing group and as 20 days in casting group.…”

Fracture union in percutaneous Kirschner wire fixation in paediatric tibial shaft fractures

“…Some authors recently advocated the use of intramedullary K-wires fixation for femoral fractures in children with encouraging results 31, 32. Nascimento et al 33 advocated flexible titanium nailing for the treatment of all diaphyseal fractures in children. The functional outcomes for the intramedullary nailing group were significantly better than those for the external fixation group in the categories of pain, happiness, sports, and global function 5 .…”

“…In this study, 63 patients underwent union in 6–10 weeks with a mean of 8 weeks. The principle of osteosynthesis with intramedullary K-wires is a biomechanical idea that aims at early bridging callus formation leading to rapid restoration of bony continuity 33 . Just like the titanium nails, the flexible K-wires allow controlled oscillating micro movements that permit changing compression on different parts of the fracture line, leading to early external callus formation.…”