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FLEXIBLE INTRAMEDULLARY NAIL FIXATION IN PEDIATRIC FEMORAL SHAFT FRACTURES

Year 2023, Volume: 5 Issue: 2, 1 - 9, 31.08.2023
https://doi.org/10.55895/sshs.837201

Abstract

Abstract
Purpose: To evaluate the functional and radiological results of intramedullary fixation with elastic titanium nails in pediatric patients between the ages of 4 and 12 years with fractures of the femoral shaft.
Methods: We retrospectively evaluated 26 patients who were treated with titanium elastic nailing in the orthopedics and traumatology clinic of Erzurum Regional Training and Research Hospital between 2016 and 2018.
Results: The average age of the patients was 8.4 ± 2.21 years (range: 4-12). Twelve (46.1%) had oblique fractures, 9 (34.6%) transverse, and 5 (19.2%) spiral. The mean follow-up period was 19.24 ± 3.84 months (range: 12-32). Complete fracture union was achieved at an average of 8.20 ± 2.06 weeks (range: 5-13). In the first postoperative year, all patients had full range of motion in the hips and knees, and there were no angular deformities. Four patients (15.3%) had leg length discrepancy of less than 2 cm and 1 patient (3.8%) more than 2 cm. In our patients, mean varus-valgus angulation was 7.14° ± 5.18° (range: 0°-16°), and mean sagittal angulation was 3.47° ± 2.86° (range: 0°-14°).
Conclusion: Although there are different treatment options for femoral shaft fractures in children aged 4-12, we believe that titanium elastic nail fixation should be the first treatment option.
Özet
Amaç: Bu çalışmamızda, 4 ile 12 yaş arasındaki femur cisim kırıklı çocuk hastalarda elastik titanyum çivi ile intramedüller tespit uygulanan femur kırıklarının fonksiyonel ve radyolojik sonuçlarını değerlendirmek
Yöntemler: 2016 ile 2018 yılları arasında, femur diafiz kırığı nedeniyle intramedüller elastik çivi ile tedavi edilen 26 hasta incelendi.
Bulgular: Hastaların ortalama yaşı 8,4±2,21 (4-12 yaş) olarak tespit edildi. Bütün kırıklar femur diyafizinde idii ve hepsi kapalı kırıktı. Kırıkların 12'si (%46,1) oblik, 9’u (%34,6) transvers, 5'i (%19,2) spiraldi. Ortalama ameliyat süresi 48,54±11,24 (35-80 dk) dakika olarak bulundu. Hastaların ortalama takip süresi 19,24±3,84 (12-32) ay idi. Ortalama 8,20±2,06 (5-13) haftada tam kaynama saptandı. Ortalama 8,87±1,7 (6-13) ayda implantlar çıkartıldı. Ameliyat sonrası birinci yılda tüm hastaların kalça ve diz hareket genişlikleri tamdı ve klinik olarak rotasyonel veya açısal deformite saptanmadı. 5 hastada (%19,2) bacak uzunluğunda 2 cm’den az eşitsizlik görüldü. Hastalarımızda ortalama 9,14±5,18 derecelik (0°-18°) varus-valgus açılanması, sagital plandada ortalama 3,47±2,86 derecelik (0°-14°) açılanma görüldü.
Sonuç: 4 ile 12 yaş arasındaki çocuklarda femur cisim kırıklarında farklı tedavi seçenekleri olsa da titanyum elastik çiviyle tespitin ilk düşünülmesi gereken tedavi seçeneği olması gerektiği görüşündeyiz.

References

  • 1. Imam MA, Negida AS, Elgebaly A, et al.(2018) Titanium Elastic Nails Versus Spica Cast in Pediatric Femoral Shaft Fractures: A Systematic Review and Meta-analysis of 1012 Patients. Arch Bone Jt Surg 6(3):176-188. 2. Hedström EM, Svensson O, Bergström U, Michno P.(2010) Epidemiology of fractures in children and adolescents. Acta Orthop 81:148-153.
  • 3. Reynolds RA, Legakis JE, Thomas R, et al.(2012) Intramedullary nails for pediatric diaphyseal femur fractures in older, heavier children: early results. Child Orthop 6:181- 188.
  • 4. Flynn JM, Schwend RM.(2004) Management of pediatric femoral shaft fractures. J Am Acad Orthop Surg 12:347-359
  • 5. Uçar BY, Gem M, Bulut M, et al.(2013) Titanium elastic intramedullary nailing: closed or mini-open reduction? Acta Orthop Belg 79:406-410.
  • 6. Flinck M, von Heideken J, Janarv PM, et al.(2015) Biomechanical comparison of semi-rigid pediatric locking nail versus titanium elastic nails in a femur fracture model. J Child Orthop 9:77-84
  • 7. Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J.(2001) Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications. J Pediatr Orthop 21:4-8.
  • 8. Buckley SL.(1997) Current trends in the treatment of femoral shaft fractures in children and adolescents. Clin Orthop Relat Res. (338):60-73.
  • 9. Poolman RW, Kocher MS, Bhandari M.(2006) Pediatric femoral fractures: A systematic review of 2422 cases. J Orthop Trauma 20: 648-54.
  • 10. Simanovsky N, Porat S, Simanovsky N, Eylon S.(2006) Close reduction and intramedullary flexible titanium nails fixation of femoral shaft fractures in children under 5 years of age. J Pediatr Orthop B. 15(4):293-7
  • 11. Ozturkmen Y, Dogrul C, Balioglu MB, Karli M.(2002) Intramedullary stabilization of pediatric diaphyseal femur fractures with elastic Ender nails. [Article in Turkish] Acta Orthop Traumatol Turc 36:220-7.
  • 12. Heinrich SD, Drvaric DM, Darr K, MacEwen GD.(1994) The operative stabilization of pediatric diaphyseal femur fractures with flexible intramedullary nails: a prospective analysis. J Pediatr Orthop 14:501-7.
  • 13. Herndon WA, Mahnken RF, Yngve DA, Sullivan JA.(1989) Management of femoral shaft fractures in the adolescent. J Pediatr Orthop 9:29-32.
  • 14. Galpin RD, Willis RB, Sabano N.(1994) Intramedullary nailing of pediatric femoral fractures. J Pediatr Orthop 14:1 8 4 - 9.
  • 15. Narayanan UG, Hyman JE, Wainwright AM, Rang M, Alman BA.(2004) Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them. J Pediatr Orthop 24:363 9.
  • 16. Ligier JN, Metaizeau JP, Prevot J, Lascombes P.(1988) Elastic stable intramedullary nailing of femoral shaft fractures in children. J Bone Joint Surg [Br] 70:74-7.
  • 17. Luhmann SJ, Schootman M, Schoenecker PL, Dobbs MB, Gordon JE.(2003) Complications of titanium 2 elastic nails for pediatric femoral shaft fractures. J Pediatr Orthop 23:4 4 3 - 7.
  • 18. Park KC, Oh CW, Byun YS, et al.(2012) Intramedullary nailing versus submuscular plating in adolescent femoral fracture. Injury 43:870-875.
  • 19. Caglar O, Aksoy MC, Yazici M, Surat A.(2006) Comparison of compression plate and flexible intramedullary nail fixation in pediatric femoral shaft fractures. J Pediatr Orthop B 15:210-214.
  • 20. Fyodorov I, Sturm PF, Robertson WW Jr.(1999) Compression-plate fixation of femoral shaft fractures in children aged 8 to 12 years. J Pediatr Orthop 19: 578-81
Year 2023, Volume: 5 Issue: 2, 1 - 9, 31.08.2023
https://doi.org/10.55895/sshs.837201

Abstract

References

  • 1. Imam MA, Negida AS, Elgebaly A, et al.(2018) Titanium Elastic Nails Versus Spica Cast in Pediatric Femoral Shaft Fractures: A Systematic Review and Meta-analysis of 1012 Patients. Arch Bone Jt Surg 6(3):176-188. 2. Hedström EM, Svensson O, Bergström U, Michno P.(2010) Epidemiology of fractures in children and adolescents. Acta Orthop 81:148-153.
  • 3. Reynolds RA, Legakis JE, Thomas R, et al.(2012) Intramedullary nails for pediatric diaphyseal femur fractures in older, heavier children: early results. Child Orthop 6:181- 188.
  • 4. Flynn JM, Schwend RM.(2004) Management of pediatric femoral shaft fractures. J Am Acad Orthop Surg 12:347-359
  • 5. Uçar BY, Gem M, Bulut M, et al.(2013) Titanium elastic intramedullary nailing: closed or mini-open reduction? Acta Orthop Belg 79:406-410.
  • 6. Flinck M, von Heideken J, Janarv PM, et al.(2015) Biomechanical comparison of semi-rigid pediatric locking nail versus titanium elastic nails in a femur fracture model. J Child Orthop 9:77-84
  • 7. Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J.(2001) Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications. J Pediatr Orthop 21:4-8.
  • 8. Buckley SL.(1997) Current trends in the treatment of femoral shaft fractures in children and adolescents. Clin Orthop Relat Res. (338):60-73.
  • 9. Poolman RW, Kocher MS, Bhandari M.(2006) Pediatric femoral fractures: A systematic review of 2422 cases. J Orthop Trauma 20: 648-54.
  • 10. Simanovsky N, Porat S, Simanovsky N, Eylon S.(2006) Close reduction and intramedullary flexible titanium nails fixation of femoral shaft fractures in children under 5 years of age. J Pediatr Orthop B. 15(4):293-7
  • 11. Ozturkmen Y, Dogrul C, Balioglu MB, Karli M.(2002) Intramedullary stabilization of pediatric diaphyseal femur fractures with elastic Ender nails. [Article in Turkish] Acta Orthop Traumatol Turc 36:220-7.
  • 12. Heinrich SD, Drvaric DM, Darr K, MacEwen GD.(1994) The operative stabilization of pediatric diaphyseal femur fractures with flexible intramedullary nails: a prospective analysis. J Pediatr Orthop 14:501-7.
  • 13. Herndon WA, Mahnken RF, Yngve DA, Sullivan JA.(1989) Management of femoral shaft fractures in the adolescent. J Pediatr Orthop 9:29-32.
  • 14. Galpin RD, Willis RB, Sabano N.(1994) Intramedullary nailing of pediatric femoral fractures. J Pediatr Orthop 14:1 8 4 - 9.
  • 15. Narayanan UG, Hyman JE, Wainwright AM, Rang M, Alman BA.(2004) Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them. J Pediatr Orthop 24:363 9.
  • 16. Ligier JN, Metaizeau JP, Prevot J, Lascombes P.(1988) Elastic stable intramedullary nailing of femoral shaft fractures in children. J Bone Joint Surg [Br] 70:74-7.
  • 17. Luhmann SJ, Schootman M, Schoenecker PL, Dobbs MB, Gordon JE.(2003) Complications of titanium 2 elastic nails for pediatric femoral shaft fractures. J Pediatr Orthop 23:4 4 3 - 7.
  • 18. Park KC, Oh CW, Byun YS, et al.(2012) Intramedullary nailing versus submuscular plating in adolescent femoral fracture. Injury 43:870-875.
  • 19. Caglar O, Aksoy MC, Yazici M, Surat A.(2006) Comparison of compression plate and flexible intramedullary nail fixation in pediatric femoral shaft fractures. J Pediatr Orthop B 15:210-214.
  • 20. Fyodorov I, Sturm PF, Robertson WW Jr.(1999) Compression-plate fixation of femoral shaft fractures in children aged 8 to 12 years. J Pediatr Orthop 19: 578-81
There are 19 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Articles
Authors

Şahin Çepni

Ali Şahin 0000-0002-2399-404X

Özay Subaşı

Publication Date August 31, 2023
Submission Date December 8, 2020
Published in Issue Year 2023 Volume: 5 Issue: 2

Cite

APA Çepni, Ş., Şahin, A., & Subaşı, Ö. (2023). FLEXIBLE INTRAMEDULLARY NAIL FIXATION IN PEDIATRIC FEMORAL SHAFT FRACTURES. Sabuncuoglu Serefeddin Health Sciences, 5(2), 1-9. https://doi.org/10.55895/sshs.837201


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