Redefining Optimal Nail to Medullary Canal Diameter Ratio in Stainless Steel Flexible Intramedullary Nailing of Pediatric Femur Fractures

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

doi:10.1097/bpo.0000000000001064

Cited by 13 publications

(13 citation statements)

References 24 publications

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“…[8][9][10][11] Other recent studies have shown no correlation between canal fill and radiographic outcome. 5,12,13 The treatment failure group in our patient series had a significantly lower mean canal fill than the success group. Our ROC analysis identified 76% as the minimum optimal canal fill to prevent treatment failure, which closely matches the generally accepted recommen-dation of at least 80%.…”

Section: Discussionmentioning

confidence: 72%

Defining Length Stability in Paediatric Femoral Shaft Fractures Treated with Titanium Elastic Nails

Shieh

Saiz

Hideshima

et al. 2021

Journal of Children's Orthopaedics

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Introduction Optimal paediatric femoral shaft fracture patterns or lengths amenable to titanium elastic nail stabilization have not been well defined. The purpose of this study is to identify radiographic parameters predictive of treatment failure with flexible intramedullary nails based upon fracture morphology. Methods A retrospective review was performed of all femoral shaft fractures treated with flexible intramedullary nails over a five-year period. All patients with at least six weeks of postoperative radiographic imaging were included. Fracture characteristics included location, pattern, length, obliquity, angulation, translation and shortening. Postoperative radiographs were reviewed to determine shortening and angulation. Results There were 58 patients with 60 femoral shaft fractures stabilized with titanium nails, with 46 healing within acceptable parameters and 14 considered malunions. Six of the 14 malunions developed complications requiring early unplanned intervention. No patients in the treatment success group had a complication. Between the treatment success and failure groups, fracture pattern, location, length, obliquity, angulation, translation or shortening were not statistically different. Mean nail canal fill was significantly lower in the failure group (0.72 versus 0.81; p = 0.0146), with a receiver operating characteristic curve identifying canal fill 76% as the optimal threshold. Conclusion This is the first study to measure the length and obliquity of paediatric femoral shaft fractures and to determine their relationship to radiographic alignment after healing. None of the preoperative fracture characteristics were predictive of malalignment or shortening. We recommend the use of larger nail sizes in the treatment of paediatric femoral shaft fractures, especially if there is concern for residual instability. Level of evidence IV

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Section: Discussionmentioning

confidence: 72%

Defining Length Stability in Paediatric Femoral Shaft Fractures Treated with Titanium Elastic Nails

Shieh

Saiz

Hideshima

et al. 2021

Journal of Children's Orthopaedics

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“… 19 The NCD ratio at the fracture level was calculated on both the anteroposterior (AP) and the lateral view. 36 Callus formation was assessed on AP and lateral view and the callus index was calculated as the maximum width of callus formation divided by the bone width at the same level ( Figure 3 ). 37 Fracture gap or overlap, and degree of horizontal fracture dislocation were assessed on the AP and the lateral view.…”

Section: Methodsmentioning

confidence: 99%

Leg length discrepancy after skeletal maturity in patients treated with elastic intramedullary nails after femoral shaft fractures in childhood

Flinck

Heideken

Aurell

et al. 2022

Journal of Children's Orthopaedics

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Purpose: The purpose was to study radiographic and perceived leg length discrepancy after skeletal maturity in patients treated for femoral shaft fractures with elastic stable intramedullary nails in childhood. Methods: Thirty-five adults underwent standing radiographs and answered a questionnaire regarding perception of leg length discrepancy. Demographic data, fracture characteristics, angulation, stability of fixation, and callus formation, at time of fracture, were assessed. Results: Mean age at fracture was 10.2 (4.9–16.7) years, and mean follow-up time was 11.1 (3.8–16.8) years. In 8 of 35 participants, the fractured limb was 11–15 mm longer than the non-fractured, and in 16, 1–10 mm longer. In eight participants, the fractured limb was 1–10 mm shorter than the non-fractured, and in three participants, 12–23 mm shorter. The younger the child, the greater the lengthening (Rs = −0.49, p = 0.003). The greater the femoral angulation at time of fracture, the greater the shortening (Rs = 0.42, p = 0.013). There was no significant correlation between stability of fixation or callus formation 1 month postoperatively and radiographic leg length discrepancy after skeletal maturity. Fourteen (40%) had perception of leg length discrepancy at follow-up, of whom eight had a radiographic leg length discrepancy of 10–24 mm. Conclusion: Treatment with elastic stable intramedullary nail of femoral shaft fracture in childhood may result in radiographic leg length discrepancy. Younger children were more prone to lengthening and should possibly be assessed before skeletal maturity. The degree of fracture stability or callus formation at the time of fracture did not significantly affect leg length discrepancy. Perception of leg length discrepancy was not necessarily associated with a radiographic leg length discrepancy (≥10 mm). Level of evidence: level IV, case series.

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“…The first type is stainless steel Kirschner FIN without coating (Steel implant). Owing to their good mechanical properties, sufficient biocompatibility and relatively low cost steel FIN are used in clinical practice for the treatment of fractures and lengthening of long tubular bones in children [5,6].…”

Section: Methodsmentioning

confidence: 99%

Flexible intramedullary nails for limb lengthening: a comprehensive comparative study of three nails types

et al. 2019

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A comparative study of flexible intramedullary nails (FIN) used for lengthening of long tubular bones in children is presented. It has been found that the presence of calcium phosphate coating obtained by micro-arc oxidation or a composite coating based on a copolymer of vinylidene fluoride with tetrafluoroethylene and hydroxyapatite on the surface of FIN significantly enhances the formation of bone regenerate in the area of osteotomy during limb lengthening by combined osteosynthesis. The investigation of physico-chemical properties of FIN with calcium phosphate coating obtained by micro-arc oxidation demonstrated that improved bone tissue formation is due to favourable conditions for adhesion, proliferation, and differentiation of MMSCs into osteoblasts on the coating surface. Composite coatings stimulated the formation of bone tissue only in vivo, mainly due to the piezoelectric properties of the copolymer of vinylidene fluoride with tetrafluoroethylene. Keywords: flexible intramedullary nails, calcium phosphate coating, vinylidene fluoride -tetrafluoroethylene, piezoelectric, combined limb lengthening 1. Introduction Deterioration of the environmental situation, primarily in industrialized countries, and rising frequency of genetic diseases provoke an increase in the number of patients and the severity of orthopaedic pathologies associated with congenital shortening and deformities of the limbs. The limb shortening, progressing as a person develops, leads to pathological changes in the entire biomechanical system. For example, overloading a healthy limb and skewing of the pelvis cause the development of pathologies associated with deformations and dislocation of the healthy hip, leading to a decrease in the quality of life. Thus, the restoration of the limb length allows solving not only the problems of orthopaedic and biomechanical recovery, but also the problem of social rehabilitation and patient's integration into society. For congenital limb length discrepancy the correction of pathology in the affected segment and functionally related elements of the biomechanical system could be done only through surgical interventions. A major contribution for solving this problem was made by outstanding orthopaedic surgeon G.A. Ilizarov, who developed the methods of surgical treatment based on distraction osteogenesis [1,2]. The recent development of G.A Ilizarov method resulted in development of combined osteosynthesis. In this approach, the external fixation devices and thin (up to 2.5 mm) flexible intramedullary nails (FIN) implanted into medullary canal of the tubular bone are used [3,4]. The circular external fixator allows to achieve the high stability of the bone fragments positioning. FIN located in the anatomical zone with multipotent cells depot and a good blood supply, allows to control the histogenesis aimed at bone tissue production. The unique anatomical location of FIN makes it one of the key elements of the combined osteosynthesis. FIN properties largely determine the clinical success of the limb leng...

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Redefining Optimal Nail to Medullary Canal Diameter Ratio in Stainless Steel Flexible Intramedullary Nailing of Pediatric Femur Fractures

Abstract: Level III.

Cited by 13 publications

References 24 publications

Defining Length Stability in Paediatric Femoral Shaft Fractures Treated with Titanium Elastic Nails

Defining Length Stability in Paediatric Femoral Shaft Fractures Treated with Titanium Elastic Nails

Leg length discrepancy after skeletal maturity in patients treated with elastic intramedullary nails after femoral shaft fractures in childhood

Flexible intramedullary nails for limb lengthening: a comprehensive comparative study of three nails types

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