Comparison of Titanium Elastic Nail and Plate Fixation of Pediatric Subtrochanteric Femur Fractures

Abstract

Therapeutic Level III.

Elastic Nailing for Pediatric Subtrochanteric and Supracondylar Femur Fractures

“…We found a complication rate of 22% (eight of 36) in patients with subtrochanteric femur fractures, which is considerably less than the 48% (12 of 25) complication rate identified by Li et al [14] but greater than the 15% (two of 13) complication rate by Pombo and Shilt [22]. Four (11%) of our patients with subtrochanteric fractures required a return to the operating room before fracture union.…”

“…Healing with an anterior angulation (apex anterior) was common after elastic nailing of pediatric subtrochanteric fractures. Fractures healed with more than 5°of angulation in 12 of 36 femurs (33%) in our study, compared to seven of 58 (12%) in the study of Flynn et al [6] and four of 25 (16%) in the study of Li et al [14]. Malalignment of greater than 10°was identified in two of our patients, compared to one in the study of Flynn et al [6].…”

“…For these fractures, the option of elastic nailing is appealing as it is minimally invasive with decreased surgical morbidity, decreased hospital stay, and earlier return to function without the need for rigid immobilization or a spica cast. The effectiveness of elastic nailing has been minimally evaluated for pediatric subtrochanteric fractures [14,22] and, to our knowledge, has not been evaluated for supracondylar femur fractures. We therefore evaluated radiographic union rates, fracture alignment, and complication rates after elastic nailing of these fractures.…”

“…Since some of these fractures are pathologic, it can limit the purchase of internal fixation. Elastic nailing has been described as a potential treatment for both pediatric subtrochanteric and supracondylar femur fractures [5,12], but its effectiveness for managing subtrochanteric fractures has only been minimally reported [14,22], and its effectiveness for managing supracondylar fractures has never been reported.…”

What’s New in Pediatric Orthopaedics

“…Li et al examined the use of titanium elastic nails compared with plate fixation in subtrochanteric femoral fractures 21 . In this multicenter retrospective study of fifty-four children, the overall complication rate was significantly higher (48%) in the titanium elastic nail group than it was in the plating group (14%).…”