Elastic stable intramedullary nailing of femoral shaft fractures in children

Ligier, J. N.; Metaizeau, J. P.; Prévot, J; Lascombes, P.

doi:10.1302/0301-620x.70b1.3339064

Cited by 412 publications

(409 citation statements)

References 2 publications

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“…In addition, patients with concomitant lower extremity fractures can be mobilized more rapidly because of the increased ability to weight bear through the extremity. The surgical technique is straightforward and is familiar to most pediatric orthopedists due to its widespread use in the treatment of other fractures in children [18,[21][22][23][24][25][26][27]. Surgical stabilization of humeral shaft fractures in children, when indicated, can be safely performed using titanium elastic nails.…”

Section: Resultsmentioning

confidence: 99%

Surgical treatment of traumatic pediatric humeral diaphyseal fractures with titanium elastic nails

Garg

Dobbs

Schoenecker

et al. 2009

Journal of Children's Orthopaedics

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Background Nearly all pediatric humeral shaft fractures can be successfully treated with closed methods. Some patients, however, require internal fixation either because of an inability to maintain an adequate reduction, significant soft tissue injury, or concomitant fractures. Methods This is a retrospective review of all traumatic humeral shaft fractures treated at our hospitals between 1999 and 2006. Thirteen pediatric patients ranging in age from 4.8 to 16.7 years (mean age 12.0 years) were treated surgically with titanium elastic nails (TENs). Relative surgical indications included open fractures, inability to maintain an acceptable reduction, the presence of ipsilateral forearm fractures (floating elbow), concomitant lower extremity fractures, and closed head injury. Two patients had associated radial nerve injury at presentation. Results The patients were followed for a mean of 29 months. All fractures healed in good alignment. There were no intraoperative complications, including neurologic or vascular injury, and no patient developed an infection postoperatively. Two patients had nail migration, one of whom developed nail protrusion through the skin. One patient with preoperative radial nerve injury ultimately underwent tendon transfer to restore wrist extension. Of the 13 patients, 12 reported a full return to sports and other activities with no limitations or discomfort. Conclusions When surgical stabilization of pediatric humeral shaft fractures is indicated, TEN fixation is effective and has a high rate of union and a low rate of complications. This technique is familiar to most orthopaedic surgeons treating pediatric fractures. Level of evidence Level of evidence: IV (case series)

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Section: Resultsmentioning

confidence: 99%

Surgical treatment of traumatic pediatric humeral diaphyseal fractures with titanium elastic nails

Garg

Dobbs

Schoenecker

et al. 2009

Journal of Children's Orthopaedics

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“…Several investigators have recommended using the largest nail diameter possible; however, the larger the nail, the more difficult it is to contour and insert. The recommended use of two flexible nails each with a diameter, i.e., 40% of the medullary canal diameter will yield a ''canal fill'' of 80% [4,9,10]. A recent study found that an 80% canal fill improved the overall biomechanical stability of the fractured femur, but often resulted in malreduction with posterior gapping [18].…”

Section: Introductionmentioning

confidence: 99%

Differences in biomechanical stability of femur fracture fixation when using titanium nails of increasing diameter

Mahar

Sink

Faro

et al. 2007

Journal of Children's Orthopaedics

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Purpose The purpose of this study was to compare the biomechanical stability generated when utilizing increasing sizes of titanium (Ti) flexible nails for fixation of simulated comminuted femur fractures. Methods Five synthetic adolescent-sized femur models were reamed to create a 9-mm canal. A 2-cm section was removed in the mid-diaphysis to simulate comminution. Each femur was first stabilized with bilateral, retrograde 3.0-mm titanium elastic nails. Femurs were tested in axial rotation and axial compression. The constructs were removed, and femurs were re-nailed with 3.5-mm nails. Identical testing was conducted. These nails were then removed, and femurs were re-nailed with 4.0-mm nails. This provided data on ''canal fill'' representing 67, 78 and 89% of the reamed canal diameter. Data for axial rotation (degrees) and failure load (N) required to produce 5 mm of fracture shortening were analyzed with a one-way ANOVA (P \ 0.05) and a Tukey's post-hoc test for multiple comparisons. Results For axial rotation, there were statistically significant improvements in rotational control for each increase in nail size. For axial stability, each increase in nail size resulted in increased axial failure loads to 5 mm, although these data were not statistically different. A specific comparison between 3.0-and 3.5-mm nails for compressive stability found significantly greater stability afforded by using 3.5-mm nails. Conclusions Data from this study demonstrate that increasing the amount of canal fill provides significant improvements in rotational control. The largest improvement was seen when increasing from 3.0-to 3.5-mm nails. While increasing the nail size from 3.5 to 4.0 mm again provided greater stability, larger nails may be more difficult to insert. Thus, increasing the nail size for femoral fracture fixation should be considered after measuring the diameter of the canal and evaluating the potential difficulty of insertion as well as specific demands of the fracture pattern.

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“…The flexible intra-medullary nailing method allows early weight bearing, rapid healing and minimal disturbance of bone growth [10] . This method has gained widespread acceptance as a safe, minimally invasive and cost effective method of treatment in children 5-15 years of age [10][11][12][13] .…”

Section: Flexible Intramedullary Nail Fixation In Paediatric Femoral mentioning

confidence: 99%

“…This method has gained widespread acceptance as a safe, minimally invasive and cost effective method of treatment in children 5-15 years of age [10][11][12][13] .…”

Section: Flexible Intramedullary Nail Fixation In Paediatric Femoral mentioning

confidence: 99%

Flexible Intramedullary Nail Fixation in Paediatric Femoral Shaft Fractures

Jadaan

Jain

Khayyat

2016

International Journal of Orthopaedics

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Elastic stable intramedullary nailing of femoral shaft fractures in children

Cited by 412 publications

References 2 publications

Surgical treatment of traumatic pediatric humeral diaphyseal fractures with titanium elastic nails

Surgical treatment of traumatic pediatric humeral diaphyseal fractures with titanium elastic nails

Differences in biomechanical stability of femur fracture fixation when using titanium nails of increasing diameter

Flexible Intramedullary Nail Fixation in Paediatric Femoral Shaft Fractures

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