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The use of elastic intramedullary nailing in the stabilisation of paediatric fractures
P Berger1, J S De Graaf, R Leemans
1Medical Hospital Leeuwarden, Department of Surgery, Henri Dunantweg 2, Postbus 888, 8901 BR Leeuwarden, The Netherlands.
Insights
Elastic intramedullary nailing is a safe and effective treatment for pediatric long-bone fractures, offering early weight-bearing and short hospital stays with minimal complications. This method is particularly suitable for children with skeletal immaturity.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Paediatric long-bone fracture treatment presents challenges.
- Elastic intramedullary nailing (EIN) is an emerging alternative.
- Controversy exists regarding optimal treatment modalities.
Purpose of the Study:
- To evaluate the efficacy and safety of elastic intramedullary nailing for paediatric long-bone fractures.
- To compare outcomes with traditional methods.
- To assess complication rates and functional recovery.
Main Methods:
- A retrospective study of 68 children with 68 fractures (forearm, femur, tibia) treated with EIN over 9 years.
- Mean patient age was 8.3 years.
- Fracture types included diaphyseal fractures in skeletally immature patients.
Main Results:
- Mean consolidation times: 7.9 weeks (forearm), 11.9 weeks (femur), 10.6 weeks (tibia).
- Early weight-bearing was achieved within one week for femur and tibia fractures.
- Low complication rates: three knee hydrops, four low-grade infections, one delayed union. Leg length discrepancy (<2 cm) in 18%.
Conclusions:
- Elastic intramedullary nailing is an excellent treatment option for diaphyseal fractures in skeletally immature children, particularly femur fractures.
- Advantages include early weight-bearing and short admission times.
- Parental preference often favors the operative approach due to perceived benefits over risks.
Unlabelled:
The treatment of paediatric long-bone fractures remains controversial. Elastic intramedullary nailing has been proposed as an alternative for the treatment of paediatric long-bone fractures.
Patients:
We treated 68 children in a time span of 9 years with 32 fractures of the forearm, 27 fractures of the femur and nine fractures of the tibia. The mean age was 8.3 years and the mean admission time 2.6 days.
Results:
Mean consolidation time was 7.9 weeks for the forearm fractures, 11.9 weeks for the femur fractures and 10.6 weeks for the tibial fractures. Full weight bearing for the latter two fracture types was allowed within the first week. There were no major complications. The complications encountered were three hydrops of the knee, four low-grade infections and one delayed union. Leg length discrepancy was only seen in five patients (18%) and was less than 2 cm.
Discussion:
In femur fractures, we let the parents decide between skeletal traction and intramedullary rods. When confronted with the possible complications (operation-related complications and infection) compared to the advantages (early weight bearing and short admission time), they almost always choose the operative approach. In our opinion, elastic intramedullary nailing is an excellent treatment option for diaphyseal fractures in children with skeletal immaturity, especially of the femur.
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