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Cortical erosion after elastic stable intramedullary nail fixation for pediatric long bone fractures: Case series

Kun-Bo Park¹, Je-Hyun Yoo², Seok Woo Kim²

¹Division of Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.

International Journal of Surgery (London, England)

|May 21, 2018

Insights

Cortical bone erosion occurred in 11.2% of pediatric long bone fractures treated with elastic stable intramedullary nails (ESIN). Diaphyseal erosion was more frequent than metaphyseal erosion, suggesting consideration for long-term ESIN retention.

Area of Science:

Pediatric Orthopedics
Biomaterials in Medicine
Skeletal Trauma Management

Background:

Elastic stable intramedullary nailing (ESIN) is a common pediatric fracture treatment.
Concerns exist regarding ESIN migration and associated cortical bone erosion.
This study aimed to determine the incidence and characteristics of cortical erosion.

Purpose of the Study:

To investigate the incidence of cortical bone erosion in pediatric long bone fractures treated with ESIN.
To analyze the relationship between erosion site (diaphysis vs. metaphysis-diaphysis junction) and ESIN.
To evaluate the occurrence of erosion independent of iatrogenic or disease-related factors.

Main Methods:

Retrospective review of 223 long bone fractures in 221 children treated with ESIN.
Inclusion criteria: ESIN in place >6 months, no initial cortical breakage.
Radiographic assessment by two pediatric orthopaedic surgeons to define cortical breakage by ESIN.

Main Results:

Cortical bone erosion (nail penetration) observed in 25 patients (11.2%).
Diaphyseal cortical erosion occurred in 15 patients (6.7%).
Metaphyseal-diaphyseal junction protrusion occurred in 10 patients (4.5%).
Average time to hardware removal in eroded cases was 14.2 months.

Conclusions:

Cortical bone erosion by ESIN can occur in pediatric long bones without underlying pathology.
Diaphyseal erosion is more prevalent than metaphyseal-diaphyseal junction protrusion.
Clinicians should consider the potential for cortical erosion in children with long-term ESIN retention.

Read full analysis

Abstract

Background:

Elastic stable intramedullary nail (ESIN) is widely used for treatment of long bone fractures in children. However, migration of the nail or cortical bone erosion in children has been reported. This study was conducted to investigate the incidence of cortical erosion according to the site and cortical erosion type.

Materials And Methods:

A total of 221 normally developing children (223 fractures) who were treated with ESIN for fractures of the long bones without cortical breakage at immediate postoperative radiography and with the ESIN in position for more than 6 months were included. Two pediatric orthopaedic surgeons reviewed all the radiographs. Cortical bone erosion was defined when the two investigators agreed that there was cortical breakage by the ESIN.

Results:

Penetration of nails through the bone cortex was observed in 25 patients (11.2%). Fifteen patients (6.7%) showed cortical erosion at the diaphysis and ten patients (4.5%) showed protrusion of the tip of the ESIN at the metaphysis-diaphysis junction. The average time for hardware removal in patients with cortical erosion was 14.2 months.

Conclusion:

Cortical bone erosion by ESIN could occur in pediatric long bones without any iatrogenic problem or disease related to the bony structure. Erosion at diaphysis was more common than at metaphysis-diaphysis junction. Cortical erosion should be considered in children who retain their ESIN for a long time.

Keywords:

Children Cortical erosion Elastic stable intramedullary nail Long bone fracture

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