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Pediatric femoral shaft fractures treated with titanium elastic nailing
Insights
A new small-incision technique for pediatric femoral shaft fractures using titanium elastic nailing (TEN) significantly reduces operative time and radiation exposure compared to traditional closed reduction, with similar clinical outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Surgical Techniques
Background:
- Pediatric femoral shaft fractures are common injuries requiring surgical intervention.
- Titanium elastic nailing (TEN) is a standard treatment, but operative time and radiation exposure can be concerns.
- Minimally invasive techniques are increasingly explored to improve surgical outcomes and patient safety.
Purpose of the Study:
- To prospectively compare a small-incision, blind-hand reduction technique with traditional closed reduction for pediatric femoral shaft fractures treated with TEN.
- To evaluate differences in intraoperative fluoroscopy time, operative time, and clinical/radiological outcomes.
Main Methods:
- A prospective study involving 68 children with femoral shaft fractures, divided into two groups (34 each).
- Group A: small-incision, blind-hand reduction with TEN.
- Group B: traditional closed reduction with TEN. Operative time, fluoroscopy time, union time, and complications were recorded; results assessed using the TEN scoring system.
Main Results:
- Mean operative time (30.5 vs 53.0 min) and fluoroscopy time (28.4 vs 65.0 sec) were significantly shorter in the small-incision group (P<.001).
- Both groups demonstrated excellent or good clinical and radiological results via the TEN scoring system, with no significant differences.
- Fracture healing time, weight-bearing time, and complication rates were comparable between the two techniques.
Conclusions:
- The small-incision, blind-hand reduction technique for TEN in pediatric femoral shaft fractures yields comparable clinical and radiological results to closed reduction.
- This minimally invasive approach significantly reduces intraoperative radiation exposure and operative time.
- Small-incision, blind-hand reduction is a viable alternative to closed reduction, offering benefits in radiation safety and efficiency.
Abstract:
The objective of this study was to prospectively compare intraoperative fluoroscopy time and clinical and radiological results in pediatric femoral shaft fractures treated with titanium elastic nailing (TEN) using a small-incision, blind-hand reduction vs closed reduction. From February 2008 to December 2009, sixty-eight children were enrolled in the study. Patients were divided into 2 groups: group A comprised 34 patients treated with a small-incision, blind-hand reduction technique and group B comprised 34 patients treated with a closed reduction technique. Operative time, intraoperative fluoroscopy time, fracture union time, and complications were recorded in both groups. Clinical and radiological results were assessed using the TEN scoring system. Mean operative time was 30.5±8.5 in group A and 53.0±15.0 minutes in group B, and mean fluoroscopy time was 28.4±18.5 seconds in group A and 65.0±28.5 seconds in group B. Operative time and fluoroscopy time were significantly longer in group B (P<.001). According to the TEN scoring system, the results were excellent in 31 patients and good in 3 patients in group A and excellent in 29 patients and good in 5 patients in group B. There was no significant difference between the 2 groups in terms of clinical and radiological results. There was also no significant difference in terms of fracture healing time, weight-bearing time, and complications. The small-incision, blind-hand reduction technique provided similar clinical results as closed reduction. This technique could be an alternative to closed reduction because it significantly reduced intraoperative radiation exposure and operative time.
