Titanium elastic nail in femur fractures as an alternative to spica cast in preschoolers

Abstract

Purpose Titanium elastic nail (TEN) as an alternative to traction and spica cast in preschool children has not been widely studied for its safety and effectiveness. Methods A cohort of 59 children with 59 fractures (nonpathological; not involving condyles or cervicotrochanteric area) were retrospectively examined. Their mean age was 4.5 ± 0.9 years and their mean weight was 14.5 ± 3.7 kg. All but five were closed (21 transverse, 19 oblique and 19 spiral). Thirty-five were caused by motor vehicle accidents and 24 by falls. There were six upper third, 27 uppermiddle junction, 14 middle third, seven lower-middle junction, and five lower third fractures. Results The mean follow-up was 41.8 ± 4.3 months, the mean hospital stay was 1.3 ± 0.87 days, and the mean time to nail removal was 20.3 ± 10.2 weeks. The mean time to union was 7.6 ± 1.5 weeks. Union was significantly correlated to age (p = 0.000) and fracture shape (p = 0.005), but not to the fracture level, nature, or mechanism. Shortening of C1.0 cm occurred in two cases (3.4 %), with an overall mean of 0.06 ± 0.21 cm. Shortening was significantly correlated to the fracture shape (p = 0.020), but not to the level. Overgrowth of C1 cm occurred in seven cases (11.9 %), with an overall mean of 0.22 ± 0.41 cm. Overgrowth was insignificantly correlated to the fracture level and shape. Frontal angulation of 5-98 occurred in six cases (10.2 %) and sagittal angulation of 3-78 occurred in seven cases (11.9 %). A rotational deformity of 108 occurred in two cases (3.4 %). Five cases had a painful nail end (8.5 %) and exteriorization with superficial infection occurred in two cases (3.4 %). Conclusion TEN is a dependable, safe, and cost-effective alternative to traction and cast in preschool children.

Cost-Effectiveness of Titanium Elastic Nail (TEN) in the Treatment of Forearm Fractures in Children

“…In Romania, inpatient care is financed by the National Health Insurance Fund (NHIF) via the Diagnosis Related Groups system. Despite the fact that the budget for health care financing shows a positive trend, the resources available for financing the healthcare system are limited, therefore cost analysis is gaining more and more importance both at national and at international levels [13,14].…”

“…Previous studies have demonstrated that this outpatient medical assistance is a significant generator of cost as well, and most probable due to increased necessity for visiting physicians, dressing, and cast removal. Patients treated by other methods than TEN have an increased need for outpatient medical assistance (13).…”

“…In the case of TEN versus other options for the treatment of long bone fractures in children, cost is also an important issue. Only a few publications have focused on the financial aspects of using TEN in children, and most of them focused on fractures of the lower limb long bones [13].…”

The Results of Retrograd Intramedullary Elastic Nailing in the Treatment of Pediatric Femoral Shaft Fractures

“…When patients were evaluated according to Flynn's criteria 14 , 14 patients (70%) had excellent results, 5 7.6 ± 1.5 weeks in Assaghir's series 29 . In Nascimento et al's 26 study that compared results of titanium elastic nailing to pelvipedal casting following traction, mean reunion time was 7.7 weeks in surgery group and 9.3 weeks in conservative treatment group.…”

Surgical management of fracture shaft femur in children and adolescents with titanium elastic nailing system

“…Due to plaster cast treatment there will be prolonged bed rest and hamper in routine activities and increased hospital expenditure [4] . In preschool children treated with casting and traction for femur shaft fractures leads to significant complications in comparision to elastic nails like angular deformity and limb length discrepancy [5] . Early weight bearing can be initiated in children treated with reamed rigid intramedullary nails for femoral shaft fractures and there are less chances of rotational malunion and angular deformity.…”