Flexible Intramedullary Nails for Femur Fractures in Pediatric Patients Heavier Than 100 Pounds

Shaha, James S.; Cage, J. Matthew; Black, Sheena R.; Wimberly, Robert L.; Shaha, Steven H.; Riccio, Anthony I.

doi:10.1097/bpo.0000000000000775

Cited by 27 publications

(17 citation statements)

References 31 publications

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“…11 However, recently, more data have emerged on the applicability of flexible nailing in the heavier (.100 lb) patient, and it has been as successful as the lighter cohort. 13 This methodology has previously been verified for quicker mobilization in children, 14 so with the limitations imposed by our patient's condition, we felt that flexible nailing could stabilize her fracture while allowing for less pain with transfers. The mindset on the feasibility of flexible nailing in the pediatric cohort has been focused on the adaptability of the nail diameters to the narrow canal size coupled with the improved ability of children to heal fractures based on secondary bone healing.…”

Section: Discussionmentioning

confidence: 70%

Flexible Femoral Nailing of an Awake Adult Muscular Dystrophy Patient

et al. 2019

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Femoral fractures can be common in nonambulatory patients with myopathies because they present with notable osteoporosis. From the orthopaedic perspective, this can be complicated by a pre-existing knee flexion contracture and small femoral shaft size. The goals of treatment are to reduce external immobilization, maximize comfort for transfers, prevent functional loss, and preclude refracture. The purpose of our work is to describe the anesthetic and orthopaedic considerations in treating a bedbound adult patient with nemaline dystrophy and a midshaft femur fracture. The authors have obtained the patient's informed written consent for print and electronic publication of the case report.

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Section: Discussionmentioning

confidence: 70%

Flexible Femoral Nailing of an Awake Adult Muscular Dystrophy Patient

et al. 2019

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“…6 Small comparative studies consisting of only stainless steel flexible nails suggest that their use may be acceptable in patients who weigh 100 pounds or more or have a length-unstable fracture. 30,31 In summary, proper patient selection and surgical management of implants during flexible intramedullary nail placement (eg, choice of metal, canal fill, and implant management at entry sites) is important. Atassi et al 32 recently reported low complication rates in a series of 101 fractures treated with flexible intramedullary nails (of which they defined 50% as "unstable").…”

Section: Flexible Intramedullary Nailsmentioning

confidence: 99%

Section: Flexible Intramedullary Nailsmentioning

confidence: 99%

Treatment of Pediatric Femoral Shaft Fractures

Greenhill

Herman

2022

J Am Acad Orthop Surg

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Diaphyseal femur fractures are common in pediatric orthopaedic settings. A patient-specific treatment plan incorporates several factors, including age, weight, fracture pattern, associated injuries, and social considerations. Nonaccidental trauma should be considered in children younger than 3 years. In general, young children are treated with noninvasive immobilization (Pavlik harness or early hip spica casting) while school-aged children are treated with internal fixation. Internal fixation options include flexible intramedullary nails, rigid locked intramedullary nails, and plate osteosynthesis. Flexible intramedullary nails have the best outcomes in children of appropriate weight, aged 5 to 11 years, with stable fracture patterns. Lateral-entry rigid intramedullary nails have been designed for use in older children. External fixation is usually reserved for complex scenarios. Regarding all treatment methods, surgeons should be aware of several technical factors necessary to optimize outcomes.

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“…Stainless-steel nails are more rigid and are often stacked to enhance canal filling [55]. Hence, many recommend the use of the more rigid stainless-steel nails for the treatment of fractures in heavier patients [57]. Proper surgical technique is also required to for optimal rotational, axial, and translational stability in these patients [5].…”

Section: Elastic Stable Intramedullary Nailing (Esin)mentioning

confidence: 99%

Pediatric Femoral Shaft Fracture: An Age-Based Treatment Algorithm

Liau

Lin

Wang

et al. 2020

IJOO

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Purpose Fractures of the femoral shaft in children are common. The rates of bone growth and remodeling in children vary according to their ages, which affect their respective management. Methods This paper evaluates the incidence and patterns of pediatric femoral shaft fracture and the current concepts of treatments available. ResultsThe type of fracture-closed or open; stable or unstable-needs to be taken into account. Child abuse should be suspected in fractures sustained by infants. For younger children, non-surgical management is preferred, which include Pavlik harness (< 6 months old) and early spica casting (6 months to 6 years old). Older children (> 6 years old) usually benefit from surgical treatments as outcomes of non-surgical alternatives are worse and are associated with prolonged recovery times. These operative measures for older children that are 6-12 years old include elastic stable intramedullary nailing and submuscular plating. Factors to be considered when devising an appropriate intervention include body mass, location of injury, and nature of fracture. For adolescent and skeletally mature teenagers (> 12 years old), rigid antegrade entry intramedullary fixation is indicated. In the event of open fractures or polytrauma, external fixation should be considered as a temporary treatment method for initial fracture stabilization. Conclusion An age-based and evidence-based algorithm has been proposed to guide surgeons in the process of evaluating an appropriate treatment.

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Flexible Intramedullary Nails for Femur Fractures in Pediatric Patients Heavier Than 100 Pounds

Abstract: Therapeutic Level III.

Cited by 27 publications

References 31 publications

Flexible Femoral Nailing of an Awake Adult Muscular Dystrophy Patient

Flexible Femoral Nailing of an Awake Adult Muscular Dystrophy Patient

Treatment of Pediatric Femoral Shaft Fractures

Pediatric Femoral Shaft Fracture: An Age-Based Treatment Algorithm

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