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Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Limb geometry after elastic stable nailing for pediatric femoral fractures
Khaled Hamed Salem1, Peter Keppler
1Department of Orthopaedic Surgery, Cairo University, 11562 Cairo, Egypt. khaled_hamedsalem@hotmail.com
Insights
Elastic stable intramedullary nailing effectively treats pediatric femoral fractures, maintaining limb length and axial alignment. However, early torsional malalignment is common with this technique.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Biomedical engineering
Background:
- Elastic stable intramedullary nailing is a common treatment for pediatric long-bone fractures.
- Potential for early limb malalignment and length discrepancies exists in pediatric femoral fractures treated with this method.
Purpose of the Study:
- To prospectively evaluate early angular, rotational malalignment, and limb-length discrepancy in pediatric femoral shaft fractures treated with elastic stable intramedullary nailing.
Main Methods:
- Sixty-eight children with unilateral femoral shaft fractures were followed.
- Malalignment was assessed using radiographs, CT, or navigated ultrasound at 4-7 months post-fixation.
Main Results:
- Mean femoral length difference was 0.5 mm lengthening; 16% had >10 mm discrepancy.
- One patient (1.5%) had >5 degrees axial deviation, but 47% had >=15 degrees of torsional malalignment.
Conclusions:
- Elastic stable intramedullary nailing offers satisfactory limb length and axial alignment for pediatric femoral fractures.
- A significant rate of early torsional malalignment is observed with this technique.
Background:
Elastic stable intramedullary nailing has become a popular treatment for pediatric long-bone fractures. However, early limb malalignment and length differences may occur in children with femoral fractures who are managed with this procedure.
Methods:
We prospectively followed sixty-eight children (mean age, 5.6 years) who were managed with elastic stable intramedullary nailing for the treatment of a unilateral femoral shaft fracture in order to evaluate early angular or rotational malalignment or limb-length discrepancy. The average body weight was 21 kg (range, 10 to 45 kg). There were fifty-seven AO/ASIF Type-A fractures and eleven Type-B fractures. Malalignment was assessed with use of radiographs, computed tomography, or navigated ultrasound examination after four to seven months to evaluate the short-term result of fixation and to eliminate changes caused by later bone remodeling.
Results:
The mean femoral length difference was 0.5 mm of femoral lengthening. Only eleven patients (16%) had a limb-length discrepancy of >10 mm. Mechanical axial deviation of >5 degrees occurred in one patient. However, the mean femoral rotational angle difference was 14.5 degrees . Thirty-two children (47%) had > or =15 degrees of torsional malalignment.
Conclusions:
Elastic stable intramedullary nailing can provide satisfactory results in terms of limb length and axial alignment, but a high rate of early torsional malalignment may be seen.
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