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Flexible intramedullary nailing versus external fixation of paediatric femoral fractures
1Department of Orthopaedics, Victoria Hospital, Blackpool, United Kingdom. khurrambarlas@btinternet.com
Insights
Flexible intramedullary nailing offers better outcomes for pediatric femoral shaft fractures compared to external fixation. This surgical technique leads to faster recovery and fewer complications in children.
Area of Science:
- Pediatric Orthopedics
- Traumatology
Background:
- Femoral diaphyseal fractures are common in children.
- Surgical interventions like external fixation and flexible intramedullary nailing are used for treatment.
Purpose of the Study:
- To compare treatment outcomes of external fixation versus flexible intramedullary nailing in pediatric femoral diaphyseal fractures.
Main Methods:
- A comparative study involving 40 children (5.4-14.1 years) with femoral diaphyseal fractures.
- Two groups: 20 treated with external fixation, 20 with flexible intramedullary nailing.
- Outcomes assessed included operative time, time to full weight bearing, range of motion, return to school, and complication rates.
Main Results:
- Flexible intramedullary nailing had a shorter average operative time (70 min vs. 52 min).
- Patients treated with flexible nails achieved full weight bearing, full range of motion, and returned to school sooner.
- The external fixator group had a higher complication rate, including pain, leg-length discrepancy, and malalignment.
Conclusions:
- Flexible intramedullary nailing is recommended for pediatric femoral shaft fractures requiring surgery.
- External fixation should be reserved for open or severely comminuted fractures.
Abstract:
Treatment outcomes were compared in two groups of children with femoral diaphyseal fractures which were treated with external fixation (20 fractures) or flexible intramedullary nailing (20 fractures). These 40 children were between 5.4 to 14.1 years of age. The duration of the operation averaged 52 minutes for the external fixator compared with 70 minutes for the flexible nail group. The time taken to gain full weight bearing, full range of movements and return to school was shorter in the flexible intramedullary nail group. There was a higher complication rate in the external fixator group than in the flexible nail group. At final review, three patients in the external fixator group had pain, two had leg-length discrepancy of up to 1 cm, and four had malalignment of 5 degrees -10 degrees. In the nailing group, there were no leg-length discrepancies or malalignments. We recommend the use of flexible intramedullary nailing for fractures of the femoral shaft in children which require surgery, and reserve external fixation for open or severely comminuted fractures.
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