Treatment of pediatric femoral shaft fractures by stainless steel and titanium elastic nail system: A randomized comparative trial

Abstract

PurposeLiterature suggests that the lower modulus of elasticity of titanium makes it ideal for use in children compared with stainless steel. Better fracture stability was observed in association with titanium nails on torsional and axial compression testing. However, stainless steel nails are stiffer than titanium counterparts, which may provide a rigid construct when fixing paediatric femoral shaft fractures. Complications have been observed more frequently by various researchers when titanium nails are used for fracture fixation in patients with increasing age or weight. The concept of this study was to compare the functional outcome after internal fixation with titanium elastic nail system and stainless steel elastic nail system in paediatric femoral shaft fractures.MethodsThe study was conducted on 34 patients admitted in the department of orthopaedics, LLRM Medical College & SVBP Hospital, Meerut, India from January 2013 to August 2014. We included patients aged 5–12 years with fracture of the femoral shaft, excluding compound fractures, pathological fractures and other lower limb fractures. Patients were treated by titanium (n = 17) or stainless steel (n = 17) elastic nail system and followed up for one year. The clinical parameters like range of motion at hip and knee joints, time to full weight bearing on the operated limb and radiological parameters like time to union were compared between two groups. A special note was made of intra- and post-operative complications. Functional outcomes were analysed according to Flynn criteria.ResultsBased on the Flynn criteria, 59% of patients had excellent results, 41% had satisfactory results, and no one showed poor results. There was no clinically significant difference between the two groups with respect to time to union and full weight bearing. But the incidence of puncture of the opposite cortex while inserting the nail and trying to advance it through the diaphysis during operation is greatly different. Only one such case was observed in titanium group but five in stainless steel group.ConclusionMajority of paediatric femoral shaft fractures are now treated operatively by elastic stable intramedullary nails. Operative intervention results in a shorter hospital stay and has economic and social benefits over conservative treatment. The cost of stainless steel nail is one third the cost of titanium nail. However, the clinico-radiological results are not significantly different between titanium and stainless steel nails at one year follow-up as observed by our study.

Comparison of efficacy between internal fixation of minimally invasive elastic stable intramedullary nail and plate in the treatment of pediatric femoral shaft fracture

“…The study found that the conventional plate fixation treatment had characteristics of longer length of surgical incision and more intraoperative bleeding although it was effective, and it had a negative impact on the prognosis of children due to the poor compliance of children. Compared with the conventional plate fixation, internal fixation of elastic stable intramedullary nail has favourable elastic restoring force as its main material is titanium alloy, which is more helpful to the stability after fracture reduction and has a positive effect for the recovery of physiological curvature of shaft of femur 17,18. Moreover it can resist the tension, pressure and rotating force at the fracture site, which is more conductive to generation of callus and can promote the early healing of fracture 19…”

Microneedle System for Transdermal Drug and Vaccine Delivery: Devices, Safety, and Prospects

“…53 However, metals are nonbiodegradable, which may produce unwanted biohazardous tip waste induced by the broken MNs left behind in the skin, even though some metals, such as SS and Ti, have been safely used as biomaterials in medical treatment for decades. 121,122…”

“…53 However, metals are nonbiodegradable, which may produce unwanted biohazardous tip waste induced by the broken MNs left behind in the skin, even though some metals, such as SS and Ti, have been safely used as biomaterials in medical treatment for decades. 121,122 Polymer. Nowadays, polymeric MNs have attracted great attention of researchers because most polymeric MNs are biocompatible and biodegradable to avoid harsh side effects in the skin, providing a safe device for the delivery of drugs.…”

Static plantar pressure and functional capacity in children with femoral shaft fractures treated by titanium elastic nailing

“…The majority of the paediatric femoral shaft fractures are now treated operatively, with economic and social benefits over conservative treatment [7]. Surgical treatment by using titanium elastic nailing (TEN) proved its efficacy when referring to hospitalization period, duration until assistive or independent walking, and returning to school [8].…”