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Elastic nailing for pediatric subtrochanteric and supracondylar femur fractures
Shital N Parikh1, Senthil T Nathan, Michael J Priola
1Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2017, Cincinnati, OH, 45229, USA, shital.parikh@cchmc.org.
Insights
Elastic stable intramedullary nailing is an option for pediatric subtrochanteric and supracondylar femur fractures, despite high complication rates. This study evaluated outcomes and risk factors for these difficult-to-treat injuries.
Area of Science:
- Pediatric Orthopedics
- Traumatology
- Surgical Techniques
Background:
- Subtrochanteric and supracondylar femur fractures present significant treatment challenges in pediatric patients.
- Limited data exists on the efficacy of elastic stable intramedullary nailing (ESIN) for these specific pediatric femur fractures.
Purpose of the Study:
- Evaluate radiographic union and fracture alignment following ESIN for pediatric subtrochanteric and supracondylar femur fractures.
- Identify and analyze complications associated with ESIN in this patient population.
- Determine risk factors that may predispose patients to complications.
Main Methods:
- Retrospective review of 36 subtrochanteric and 8 supracondylar femur fractures treated with ESIN between 2005 and 2011.
- Radiographic assessment of fracture alignment and union.
- Chart review to identify and categorize complications.
- Nonparametric statistical tests to compare patients with and without complications.
Main Results:
- All fractures achieved radiographic union. Approximately 70% of subtrochanteric and 71% of supracondylar fractures healed with acceptable alignment.
- Complication rates were 22% for subtrochanteric and 38% for supracondylar fractures, including malunion, nail issues, and infection.
- Motor vehicle accidents were identified as a risk factor for complications in subtrochanteric fractures.
Conclusions:
- Despite a high rate of complications, elastic stable intramedullary nailing is a viable treatment option for complex pediatric femur fractures.
- Careful patient selection and monitoring are essential to optimize outcomes for subtrochanteric and supracondylar femur fractures treated with ESIN.
Background:
Subtrochanteric and supracondylar femur fractures are difficult injuries to treat in children. Although elastic stable intramedullary nails are commonly used for pediatric femur shaft fractures, there is little information on their effectiveness for managing pediatric subtrochanteric and supracondylar femur fractures.
Questions/Purposes:
We (1) evaluated radiographic union rates and fracture alignment after elastic nailing of pediatric subtrochanteric and supracondylar femur fractures, (2) identified complications, and (3) determined risk factors for complications.
Methods:
Between 2005 and 2011, 36 subtrochanteric fractures and eight supracondylar femur fractures were treated with elastic stable intramedullary nails and had complete followup until clinical and radiographic union. Elastic nailing was used for subtrochanteric fractures in children 5 to 12 years of age or after failed spica cast treatment in younger children and for displaced supracondylar fractures in children older than 5 years. Fracture alignment and union were measured on radiographs, and complications were identified from review of patient charts. Patients with and without complications were compared using nonparametric tests to identify risk factors.
Results:
All fractures healed; 23 of 33 (70%) subtrochanteric femur fractures and five of seven (71%) supracondylar femur fractures healed with anterior angulation of about 5°. For subtrochanteric fractures, complications included repositioning/removal of nails before radiographic union (n = 4), malunion (n = 2), fracture (n = 1), irritation (n = 1) at nail insertion site, and limb length discrepancy (n = 1); despite these complications, there were 22 (61%) excellent, 12 (33%) satisfactory, and only two (6%) poor outcomes. For supracondylar fractures, complications included infection after nail removal (n = 1) and nail site irritation (n = 2); there were three (38%) excellent, five (62%) satisfactory, and no poor outcomes. Complications were more likely after subtrochanteric fracture during motor vehicle accident (p = 0.045).
Conclusions:
Although complication rates are high with elastic nailing for pediatric subtrochanteric (22%) and supracondylar (38%) femur fractures, elastic nailing represents an important option for difficult-to-manage femur fractures.
Level Of Evidence:
Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
