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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
[Therapy of pediatric femoral fractures. Two versus three elastic stable intramedullary nails]
A Semaan1, T Klein, T M Boemers
1Klinik für Kinderchirurgie und Kinderurologie, Kinderkrankenhaus, Kliniken der Stadt Köln gGmbH, Amsterdamer Str. 59, 50735, Köln, Deutschland, papers.semaan@gmail.com.
Insights
Using three elastic stable intramedullary nails (ESINs) for pediatric femoral fractures offers no advantages over two ESINs. Three ESINs resulted in leg length discrepancy and hip joint mobility issues, suggesting two ESINs are preferable.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Biomechanical analysis
Background:
- Conservative treatment of pediatric femoral fractures involves prolonged immobilization, causing significant burdens.
- Elastic stable intramedullary nailing (ESIN) offers a shorter immobilization period and improved outcomes compared to conservative methods.
- This study investigates the comparative efficacy of two versus three ESINs for pediatric femoral shaft fractures.
Purpose of the Study:
- To compare the outcomes of using two versus three elastic stable intramedullary nails (ESINs) in treating pediatric femoral shaft fractures.
- To evaluate potential differences in leg length discrepancy, joint mobility, and surgical time between the two techniques.
Main Methods:
- Retrospective analysis of pediatric patients treated with ESINs for femoral fractures between 2009 and 2012.
- Standardized follow-up examinations assessed leg length discrepancy and hip/knee joint range of motion.
- Surgical time for implant removal was also recorded and compared.
Main Results:
- Treatment with three ESINs led to statistically significant leg length discrepancy (p=0.013) and impaired hip joint movement (p=0.029).
- The surgical time for removing three ESINs was significantly longer (p=0.046).
- No significant differences were observed in other evaluated parameters between the two and three ESIN groups.
Conclusions:
- Using three ESINs for pediatric femoral shaft fractures provides no discernible benefits over using two ESINs.
- The observed leg length discrepancy with three ESINs may stem from asymmetrical support, leading to increased micromovement and callus formation.
- Current evidence suggests that three ESINs should not be routinely used for treating pediatric femoral fractures.
Background:
The conservative treatment of pediatric femoral fractures can be socially and financially burdensome for patients and families due to the long period of immobilization. New operative techniques have consistently gained significance in the treatment of such fractures due to a shorter period of immobilization. Elastic stable intramedullary nailing (ESIN) in particular has been proven to lead to better outcome in comparison to conservative treatment. This article presents the first study that compares the outcome of three versus two ESINs in the treatment of pediatric femoral shaft fractures.
Material And Methods:
A retrospective analysis of all patients who underwent operative treatment of femoral fractures with ESINs in our hospital from 2009-2012 was carried out. A follow-up examination was performed in mid-2013 by standardized evaluation of leg length discrepancy and the movement capacity of the hip and knee joint.
Results:
The follow-up examination revealed a leg length discrepancy of the injured leg when three ESINs were used (p = 0.013) and an impairment of the movement capacity in the hip joint of the injured leg (p = 0.029). In addition the surgery time for metal removal of three ESINs was higher (p = 0.046). All other evaluated parameters did not show any differences.
Conclusion:
In this study population the treatment of pediatric femoral shaft fractures with three ESINs showed no benefit in comparison to two ESINs and therefore should not be used to treat femoral fractures. The leg length discrepancy using three ESINs may be explained by a nonsymmetrical distribution of support points leading to an increased micromovement of the bone with increased callus formation.
