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Early experience with titanium elastic nails in a trauma unit
M H Shah1, G Heffernan, A J McGuinness
1Cork University Hospital, Wilton, Cork, Ireland.
Insights
The Titanium Elastic Nail (TEN) provides effective treatment for pediatric long bone fractures, significantly reducing hospital stays. While generally successful, minor complications like insertion pain and superficial infections were noted.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Biomaterials
Background:
- Traditional treatments for pediatric long bone fractures often involve prolonged immobilization and hospitalization.
- The Titanium Elastic Nail (TEN) presents a minimally invasive alternative with potential benefits for pediatric fracture management.
Purpose of the Study:
- To evaluate the early clinical experience and outcomes of using Titanium Elastic Nails (TEN) for treating long bone fractures in children.
- To assess the efficacy and safety of TEN fixation in a pediatric cohort.
Main Methods:
- A retrospective review of 13 pediatric patients treated with TEN for various long bone fractures over two years.
- Clinical and radiological assessments were performed to evaluate fracture union, alignment, and complications.
Main Results:
- All 13 fractures achieved union, with significant reductions in hospital stay, particularly for femoral fractures (5-8 days).
- Minor complications included one case of delayed union requiring bone grafting, one instance of positional loss, insertion site pain in 4 patients, and two superficial wound infections.
- No deep infections, limb length discrepancies, or rotational/angular malalignments were observed.
Conclusions:
- Titanium Elastic Nails (TEN) demonstrate a favorable outcome for pediatric long bone fractures, offering advantages in reduced hospital stay and early mobilization.
- While generally safe and effective, careful patient selection and monitoring are important to manage potential complications such as delayed union and insertion site issues.
Abstract:
The Titanium Elastic Nail (TEN) offers a number of potential advantages over traditional ways of treating long bone fractures particularly in the paediatric population. These advantages include earlier mobilisation and shorter hospital stay and less risk of loss of fracture position. These advantages are most apparent and significant when treating femoral fractures in children where the length of hospital stay is reduced from several weeks to a typical period of 5 to 8 days. We have reviewed our early experience of using these implants over the past 2 years. Patients were assessed clinically and radiologically. 13 patients were treated using the TEN during this period. There were 2 femoral fractures, 4 humeral fractures, 1 tibial and 6 forearm fractures treated using the Titanium Elastic Nail. All fractures united during the study period. However 1 humeral fracture required a secondary bone grafting and plating for delayed union and 1 fracture lost position during follow-up. Insertion point pain was a problem in 4 patients but this resolved after nail removal in all. There was 1 superficial wound infection which resolved with antibiotics and 1 superficial wound infection of an open fracture wound which resolved following nail removal and antibiotics. There were no cases of deep infection. There were no limb length discrepancy or rotational or angular malalignment problems. Biomechanical principles and technical aspects of this type of fixation are discussed.
