Closed, Locked Intramedullary Nailing of Pediatric Femoral Shaft Fractures Through the Tip of the Greater Trochanter

Kanellopoulos, Anastasios D.; Yiannakopoulos, Christos K.; Soucacos, P.N.

doi:10.1097/01.ta.0000199913.02341.d6

Cited by 56 publications

(35 citation statements)

References 25 publications

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“…Although we did not note any instance of osteonecrosis of the femoral head in our group, that is a potentially catastrophic complication 3,20,21 . The recent introduction of trochanteric nails may address this risk 22 , but there is at least one documented case report of osteonecrosis of the femoral head after use of a trochanteric entry point 23 .…”

Section: Discussionmentioning

confidence: 99%

Femoral Fractures in Adolescents: A Comparison of Four Methods of Fixation

Ramseier

Janicki

Weir

et al. 2010

The Journal of Bone and Joint Surgery-American Volume

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Section: Discussionmentioning

confidence: 99%

Femoral Fractures in Adolescents: A Comparison of Four Methods of Fixation

Ramseier

Janicki

Weir

et al. 2010

The Journal of Bone and Joint Surgery-American Volume

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“…This method has yielded good results, but most of the studies were performed on adult subjects [16][17][18]44]. One study showed that rigid nail insertion through the greater trochanter in adolescents results in satisfactory patient outcomes, although the nails used for this study were designed for insertion through the piriformis fossa [26]. In a case series of 78 patients, the use of a modified rigid humeral nail inserted laterally to the trochanteric tip has been shown to be effective with few complications [27].…”

Section: Discussionmentioning

confidence: 99%

“…When ESINs are used, there is an increased incidence of malunion and limb length discrepancy, in addition to pain and irritation at the implant insertion site [1,34]. The use of more rigid nails designed for antegrade insertion through the piriformis fossa has largely been abandoned because of the potential for AVN of the femoral head, a devastating complication with lifelong consequences [24,26,27,43]. The potential for this complication can be avoided by inserting the nail through the greater trochanter.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, rigid IMNs inserted laterally to the greater trochanter tip have been used successfully for treatment of pediatric femur fractures, but these were modified nails, not designed for this purpose or point of entry [20,[26][27][28]. There is limited evidence in the literature supporting the use of rigid nails for pediatric femur fractures [29], as shown in the recent AAOS practice guideline summary [30].…”

Section: Introductionmentioning

confidence: 99%

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Intramedullary nails for pediatric diaphyseal femur fractures in older, heavier children: Early results

Reynolds

Legakis

Thomas

et al. 2012

Journal of Children's Orthopaedics

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Purpose A common treatment for pediatric femur fractures is intramedullary nail (IMN) insertion. Elastic stable intramedullary nails (ESINs) are often used for these procedures in heavier patients, but the potential for complications and malunion is greater. We describe here a rigid IMN specifically designed for adolescents, the adolescent lateral entry femoral nail (ALFN). The purpose of this study was to compare the recovery and complications for patients treated with ESINs to those treated with the ALFN. Methods Our study design was a retrospective cohort study. We performed a review of medical records of 22 children ages 10-17 requiring surgical fixation of a femur fracture for a 2 -year period. Patients selected for the study had traumatic diaphyseal femur fractures and were treated with ESINs without end-caps or ALFNs. Our analyses evaluated injury, surgical, and outcome information for all patients. Results Twenty-two patients were eligible for inclusion and were divided into two groups according to their treatment: the ESIN group with 7 patients and the ALFN group with 15 patients. We then performed a comparison of complications and recovery for these patients. The mean time to full weight-bearing was significantly less for the ALFN group (4.1 weeks; SD, 2.2), than the ESIN group (9.4 weeks; SD 3.9). There was no statistical difference in the incidence of major or minor complications. Conclusions Older, heavier pediatric patients treated for femur fracture with ALFNs had a shorter recovery time than similar patients treated with ESINs. However, the outcomes for both groups were satisfactory.

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“…For most patients younger than 5 years old, the initial treatment of choice is with hip spica with or without initial traction, which can give satisfactory results [4], while in older patients conservative treatment provides less satisfactory results [5,6]. In adolescent patients, nonoperative treatment does not always ensure complete fracture site rotational and translational stability, often resulting in angular and rotational deformities as well as in limb length discrepancy [7].…”

Section: Introductionmentioning

confidence: 99%

Intramedullary Kirschner wire (K-wire) fixation of femoral fracture in children

Jawadi

Abdul-Samad

2007

Journal of Children's Orthopaedics

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Purpose The aim of this study was to evaluate the efficacy of standard intramedullary Kirschner wires (K-wires) for the treatment of femoral shaft fracture in children. Methods We report the results of intramedullary K-wires nailing in 178 children with a mean age of 7.7 years (range, 4-14 years) from 2000 to 2005, retrospectively. A total of 184 diaphyseal femoral fractures were treated with both antegrade and retrograde nailing using the same principles of elastic stable intramedullary nailing (ESIN). The patients were followed for 12 months on average (range, 6-24 months).Results No major complication (limb length discrepancy [15 mm, non-union, avascular necrosis, knee joint stiffness) occurred during the observation period. All fractures healed within 7.1 weeks on average (range, 5-12 weeks). Associated injuries were seen in 16.9% of the cases. All but seven fractures were reduced by closed manipulation. Early mobilization and weight bearing was allowed. Intramedullary K-wires were removed after an average of 4.8 months (range, 3-12 months) without any complications. Conclusions In children, intramedullary fixation by using standard K-wires provides effective treatment for the diaphyseal femoral fracture that has excellent clinical results. Each intramedullary K-wire costs US $5, which adds a cost effective advantage to this method of treatment.

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Closed, Locked Intramedullary Nailing of Pediatric Femoral Shaft Fractures Through the Tip of the Greater Trochanter

Cited by 56 publications

References 25 publications

Femoral Fractures in Adolescents: A Comparison of Four Methods of Fixation

Femoral Fractures in Adolescents: A Comparison of Four Methods of Fixation

Intramedullary nails for pediatric diaphyseal femur fractures in older, heavier children: Early results

Intramedullary Kirschner wire (K-wire) fixation of femoral fracture in children

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