Retrograde flexible intramedullary nailing in children's femoral fractures

Oh, Chang-Wug; Park, Byung‐Chul; Kim, Poong-Taek; Kyung, Hee-Soo; Kim, Sung-Jung; Ihn, Joo-Chul

doi:10.1007/s00264-001-0304-6

Cited by 55 publications

(37 citation statements)

References 23 publications

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“…Over the past few years, the literature has been fed by an increasing number of reports on flexible intramedullary nailing as a safe method, which is also reproducible in the treatment of this group of patients [15][16][17][18][19][20][21]. One year ago, the early results of the treatment of femoral fractures with steel flexible nails in the HUSVP were published [17], in view of which we decided to assess the technique in the long term, in order to compare our results with those published in the literature.…”

Section: Discussionmentioning

confidence: 99%

Femoral shaft fractures treated with stainless steel flexible nails in children aged between 5 and 12 years at the HUSVP: A two-year follow-up

Ríos

Arango

Valderrama-Molina

et al. 2009

Journal of Children's Orthopaedics

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Purpose The purpose of this study is to show our experience with stainless steel flexible nails in the treatment of femoral shaft fractures in children aged between 5 and 12 years and to observe if the type of material used for nails affects the results. Materials A prospective, descriptive study of a series of cases was performed to evaluate patients treated at the Hospital Universitario San Vicente de Pau´l (HUSVP) who had been followed up for at least 24 months. Results The study group was composed of 48 patients, with an average age of 8.6 years. According to the AO classification, the most common type of fracture was 32A3.2 (61%). The average follow-up period was 43 months. The alterations observed were six cases of clinical length discrepancy, two cases of overgrowing, four cases of shortening, and two malunions in valgus. These alterations had no repercussion in the children's function.The follow-up is the main strength of this study, as it demonstrated that, 2 years after surgery. Conclusion The results with stainless steel nails are as good as those with titanium nails with a shorter follow-up as reported in the literature. Given the high costs of osteosynthesis material in our country, the results of this study provide a less expensive alternative. Level of evidence IV, case series.

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Section: Discussionmentioning

confidence: 99%

Femoral shaft fractures treated with stainless steel flexible nails in children aged between 5 and 12 years at the HUSVP: A two-year follow-up

Ríos

Arango

Valderrama-Molina

et al. 2009

Journal of Children's Orthopaedics

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“…13,21 This is primarily due to early mobilization of the patient which can be initiated as compared to other conservative treatments.…”

Section: -13mentioning

confidence: 99%

Flexible intramedullary nails: the panacea for paediatric femoral shaft fractures

et al. 2017

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Background: Management of pediatric femoral shaft fractures continues to evolve with time with flexible intramedullary nailing being one of the options to treat a specific age group of children. Grey zone exists concerning the cost effectiveness and appropriate timing of nail removal in treating such fractures. The objective of the study was to evaluate the treatment outcome of fracture shaft of the femur in children in the age group of 5- 12 years with flexible intramedullary nail.Methods: The study comprised of 30 consecutive cases of acute fractures of the femoral shaft in children of the age group of 5 to 12 years. Only closed fractures of the mid-diaphyseal region of the femur were included while supracondylar, subtrochanteric and pathological fractures were excluded. Flexible intramedullary nails of stainless steel (n=24) or titanium (n=6) were used for fixation of these fractures.Results: Evaluation of the results was done according to the criteria by Flynn et al. 21(70%) out of 30 patients had an excellent result and remaining 9 (30%) had a satisfactory result. All fractures united with a full range of motion at the hip and knee joint without any major complications. Conclusions: Intramedullary elastic nailing of simple diaphyseal femur fractures in children is an effective method with negligible complications. Treatment cost can be significantly lowered by using the much cheaper stainless steel flexible nails rather than the more expensive titanium nails.

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“…Some authors have therefore recommended additional stabilisation with screws or external fixation when dealing with long spiral or other complex fractures. 6,15,16 We have previously investigated ways of modifying the materials and technique of ESIN in an attempt to improve stability: using in vitro biomechanical studies we have been able to demonstrate that stainless steel nails provide greater stability than titanium nails, 17 but we were unable to show increased stability with the use of end-caps. 18 The aim of this study was to determine the effects on stability of pre-bending the nails.…”

mentioning

confidence: 93%

Increasing stability by pre-bending the nails in elastic stable intramedullary nailing

Kaiser¹,

Zachert²,

Wendlandt³

et al. 2012

The Journal of Bone and Joint Surgery. British volume

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Elastic stable intramedullary nailing (ESIN) is generally acknowledged to be the treatment of choice for displaced diaphyseal femoral fractures in children over the age of three years, although complication rates of up to 50% are described. Pre-bending the nails is recommended, but there are no published data to support this. Using synthetic bones and a standardised simulated fracture, we performed biomechanical testing to determine the influence on the stability of the fracture of pre-bending the nails before implantation. Standard ESIN was performed on 24 synthetic femoral models with a spiral fracture. In eight cases the nails were inserted without any pre-bending, in a further eight cases they were pre-bent to 30° and in the last group of eight cases they were pre-bent to 60°. Mechanical testing revealed that pre-bending to 60° produced a significant increase in the stiffness or stability of the fracture. Pre-bending to 60° showed a significant positive influence on the stiffness compared with unbent nails. Pre-bending to 30° improved stiffness only slightly.These findings validate the recommendations for pre-bending, but the degree of pre-bend should exceed 30°. Adopting higher degrees of pre-bending should improve stability in spiral fractures and reduce the complications of varus deformity and shortening.

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Retrograde flexible intramedullary nailing in children's femoral fractures

Cited by 55 publications

References 23 publications

Femoral shaft fractures treated with stainless steel flexible nails in children aged between 5 and 12 years at the HUSVP: A two-year follow-up

Femoral shaft fractures treated with stainless steel flexible nails in children aged between 5 and 12 years at the HUSVP: A two-year follow-up

Flexible intramedullary nails: the panacea for paediatric femoral shaft fractures

Increasing stability by pre-bending the nails in elastic stable intramedullary nailing

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