Titanium Elastic Nails Are a Safe and Effective Treatment for Length Unstable Pediatric Femur Fractures
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Ali A Siddiqui1,2, Oussama Abousamra1,2, Edward Compton1,2
1Children's Orthopaedic Center, Children's Hospital Los Angeles.
Insights
Titanium elastic nails (TENs) are safe and effective for pediatric femur fractures, regardless of fracture stability. This study found no difference in complications or reoperations between length-unstable and length-stable femur fractures treated with TENs.
Area of Science:
- Pediatric Orthopedics
- Pediatric Trauma Surgery
- Biomaterials in Orthopedics
Background:
- Treatment of pediatric femoral shaft fractures, particularly length-unstable types, remains a subject of debate.
- Titanium elastic nails (TENs) are a common fixation method for these fractures.
Purpose of the Study:
- To evaluate the outcomes of skeletally immature children with length-unstable femur fractures treated with TENs.
- To compare complication and reoperation rates between length-unstable and length-stable pediatric femur fractures treated with TENs.
Main Methods:
- Retrospective review of pediatric femoral shaft fractures treated with TENs from April 2006 to January 2018.
- Exclusion of patients aged 11+, weighing over 50kg, with pathologic fractures, or neuromuscular disorders.
- Fractures classified as length-unstable (spiral, comminuted, long oblique) or length-stable (transverse, short oblique) and outcomes compared.
Main Results:
- 57 patients (58 fractures) with a mean age of 5 years were included.
- No significant difference in age, weight, or follow-up duration between length-unstable and length-stable groups.
- Similar rates of major and minor complications and reoperations were observed between the two groups, with no significant difference in time to union.
Conclusions:
- Titanium elastic nails (TENs) demonstrate comparable safety and efficacy for both length-unstable and length-stable pediatric femoral shaft fractures.
- TENs are a suitable option for operative fixation of length-unstable femoral shaft fractures in children.
- The study supports the use of TENs irrespective of fracture pattern stability in pediatric femur fractures.
Background:
Controversy exists regarding the treatment of length unstable pediatric femoral shaft fractures. The purpose of this study was to investigate the outcomes of skeletally immature children with length unstable femur fractures treated with titanium elastic nails (TENs).
Methods:
A retrospective review was conducted on all patients with femoral shaft fractures at a tertiary care pediatric hospital from April 2006 to January 2018. Patients with femoral shaft fractures treated with TEN and minimum 6 months follow-up were included. Exclusion criteria were age 11 years or above, weight >50 kg, pathologic fracture, and neuromuscular disorders. Femur fractures were categorized into 2 groups: length unstable (spiral, comminuted, or long oblique fractures) versus length stable (transverse and short oblique). Complications and reoperations were compared between the groups.
Results:
A total of 57 patients with 58 femoral shaft fractures were included. The mean age was 5±2 (1 to 11) years and mean follow-up was 20.4±18.1 (6.0 to 81.2) months. The mean weight was 22.9±7.7 (11.0 to 40.5) kg. There was no difference in age (P=0.32), weight (P=0.28) or follow-up length (P=0.57) between patients with length unstable fractures and those with length stable fractures. A total of 32/58 (55%) fractures were length unstable and 26/58 (45%) were length stable. Mean time to union was 4.6 months, and there was no significant difference in mean time to union between the 2 groups (P=0.71). Thirty-one complications occurred in 27 patients. There was no difference between groups in the incidence of major complications requiring revision surgery (P=0.68) and minor complications that did not require revision surgery (P>0.99).
Conclusions:
In children with femoral shaft fractures treated with TEN, there was no difference in the incidence of complications or reoperations between those with length unstable fractures and those with length stable fractures. TEN are a safe and effective choice for operative fixation of length unstable femoral shaft fractures in children.
Level Of Evidence:
Level III-retrospective comparative study.
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