Use of external fixator versus flexible intramedullary nailing in closed pediatric femur fractures: comparing results using data from two cohort studies

Wani, Mubashir Maqbool; Rashid, Mamunur; Dar, Reyaz Ahmad; Bashir, Arshad; Sultan, Asif; Wani, Iqbal; Rashid, Shakir; O’Sullivan, Mark

doi:10.1007/s00590-015-1737-8

Cited by 7 publications

(1 citation statement)

References 19 publications

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“…14 Wani et al reported similar results but recommended that the decision be left to the surgeon, as certain fractures, such as very distal or proximal fractures, may benefit from external fixation. 15 Chen et al found that the use of FIN was associated with a shorter operative time, less blood loss and shorter length of hospitalisation compared to submuscular plating. 16 Concerns with antegrade nailing are that the blood supply to the femoral head may be compromised and that penetration through the greater trochanteric epiphysis may lead to epiphysiodesis and proximal femoral growth deformities.…”

Section: Discussionmentioning

confidence: 99%

Antegrade flexible intramedullary nailing through the greater trochanter in paediatric femur shaft fractures

et al. 2019

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Aims: To determine whether an antegrade approach, through the tip of the greater trochanter, in femoral shaft fractures in children, is safe, achieves adequate union and results in significant proximal femoral growth complications. Patients and methods: The case records and radiographs of 23 paediatric patients aged 7 to 12 years with femur shaft fractures managed with stainless steel antegrade flexible nailing were reviewed retrospectively. Pre-operative radiographs were reviewed for fracture pattern, level and comminution. Post-operative radiographs were reviewed to assess for union, alignment, osteonecrosis of the femoral head and epiphysiodesis of the greater trochanter. Morphological changes of the proximal femur were assessed by comparing the neck shaft angle and articulo-trochanteric distance with the opposite hip. Case records were reviewed for post-operative complications, patient-reported complaints and leg length discrepancy. Clinical outcomes were assessed with the criteria established by Flynn. Results: All patients achieved union, and none had evidence of osteonecrosis of the femoral head on follow-up. Three patients had malalignment and two patients had radiographic evidence of greater trochanteric epiphysiodesis. Two patients had morphological changes of the proximal femur, with one having an increased neck shaft angle and one an increased articulo-trochanteric distance. One patient had a leg length discrepancy of 2 cm. Fifteen patients had excellent clinical outcomes, five had satisfactory outcomes and three had poor outcomes according the criteria established by Flynn. Conclusion: Antegrade entry through the tip of the greater trochanter does not appear to compromise the blood supply to the femoral head or increase the risk of clinically significant morphological changes to the proximal femur. All patients achieved adequate union. Furthermore, antegrade insertion avoided skin problems and prominent nail complications around the knee seen with retrograde insertion.

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Section: Discussionmentioning

confidence: 99%