Outcome of titanium elastic nailing in pediatric subtrochanteric femur fractures: A case series

Abstract

Introduction: Subtrochanteric femur fractures are difficult injuries to treat in children. Although elastic stable intramedullary nails are commonly used for pediatric femur shaft fractures, there is little information on their effectiveness for managing pediatric subtrochanteric femur fractures. We are not aware of any published study that defines outcome of titanium elastic nail in treatment of pediatric subtrochanteric femur fractures. We, in this study, evaluated radiographic union rates, fracture alignment, and complications after titanium elastic nailing of pediatric subtrochanteric femur fractures. Materials and Methods: A total of 10 cases of pediatric subtrochanteric femur fractures were admitted in our department between November 2016 and April 2018. This prospective study included 8 males and 2 females, with a mean age of 7.9 years (5-11 years). All patients were treated with elastic stable intramedullary nails and had complete follow up until clinical and radiographic union. Results: All patients had clinical healing with full weight-bearing and the functional outcome scores were satisfactory. No cases of infection were reported at the time of the last follow-up visit. Complications included malunion (n = 1), irritation (n = 1) at nail insertion site, and limb length discrepancy (n = 1). Despite these complications, there were 7 (70%) excellent, 3 (30%) satisfactory, and none with poor outcomes. Conclusions: Titanium elastic nailing is an important option for treating subtrochanteric femur fractures in children with low complication rates.

Treatment of subtrochanteric fracture in children:Titanium elastic nails versus plate and screws

“…No major complication that needed reoperation or unplanned removal of implants were recorded so no poor outcome according to Flynn outcome score. This goes in line with Pombo et al, (9) , Barua et al, (6) and Alberghina et al, (8) . Though, Patil and Abdul Azeem (5) who reported 8% poor results.…”

“…Leg length discrepancy was the commonest complications found in 20% of case and this goes in line with Patil and Abdul Azeem ( 5) , Parikh et al, (7) and Barua et al, (6) .Unlike Alberghina et al, (8) who recorded no cases suffered such complication. No major complication that needed reoperation or unplanned removal of implants were recorded so no poor outcome according to Flynn outcome score.…”

“…Patil and Abdul Azeem (5) recorded average follow up duration that was higher than the current study but their study was retrospective study. The current study has average follow up higher than other prospective studies such Barua et al, (6) study.…”

“…Patil and Abdul Azeem (5) and Barua et al, (6) concluded in his study that Length unstable fracture have higher complication rate when treated with titanium elastic nails. In the contrary, the present and Rathjen et al, (10) studies suggested no difference in complication or overall outcome using TENs for length stable or unstable fracture patterns.…”

“…We 6) . Patil and Abdul Azeem (5) recorded average follow up duration that was higher than the current study but their study was retrospective study.…”