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Use of external fixator versus flexible intramedullary nailing in closed pediatric femur fractures: comparing results
Mubashir Maqbool Wani1, Mubashir Rashid2, Riyaz Ahmad Dar3
1Department of Orthopaedics, Medical College Srinagar, Hospital for Bone and Joint Surgery, Barzulla, J&K, 190005, India. mubashirmaqboolwani@yahoo.co.in.
Insights
External fixation (EF) and flexible intramedullary nailing (FIN) are common treatments for pediatric femur fractures. FIN showed faster radiographic union (10.06 weeks) than EF (12.23 weeks), though both methods have potential complications.
Area of Science:
- Orthopedic surgery
- Pediatric trauma care
Background:
- External fixation (EF) and flexible intramedullary nailing (FIN) are established treatments for pediatric femur fractures.
- Comparative outcome data between EF and FIN is limited.
Purpose of the Study:
- To compare the clinical outcomes of external fixation (EF) versus flexible intramedullary nailing (FIN) for pediatric femur fractures.
Main Methods:
- A retrospective comparison of two patient groups: 45 treated with EF and 50 with FIN.
- Outcomes were assessed based on union time, complications, and re-operation rates.
Main Results:
- Flexible intramedullary nailing (FIN) demonstrated a shorter average radiographic union time (10.06 weeks) compared to external fixation (EF) (12.23 weeks).
- Pin-site infections were more frequent in the EF group. One re-fracture occurred in the EF group, and one case of significant anterior angulation required re-operation in the FIN group.
Conclusions:
- Both external fixation and flexible intramedullary nailing are viable options for pediatric femur fractures, with surgeon discretion guiding treatment choice.
- Further randomized controlled trials are recommended to definitively compare these surgical modalities.
Purpose:
Although external fixation and flexible intramedullary nailing have been extensively used in the management of pediatric femur fractures, there are very few studies, which have compared the results. The purpose of the study was to compare the results of external fixation and flexible intramedullary nailing in pediatric femur fractures.
Methods:
Two groups of patients were treated by external fixator (EF) and flexible intramedullary nailing (FIN) over two different but successive time periods and results compared. The first group (EF) consisted of 45 patients, and the second group had 50 patients.
Results:
The age in EF group ranged from 6 to 14 years (average 9.93 years), and the age in FIN group ranged from 6 to 11 years (average 7.66 years). In the EF group, fixator was removed at an average of 12.23 weeks. In the FIN group, radiographic union was evident at an average time of 10.06 weeks. Pin-site infection was common in EF group. One patient had a re-fracture in EF group, and one patient had to be re-operated in FIN group after he developed anterior angulation of more than 30°.
Conclusion:
We believe that it is the discretion of the surgeon to operate on the femur fracture using either of the treatment modalities. Further randomized studies need to be conducted between these two treatment modalities.
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