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"Unstable" Pediatric Femoral Shaft Fractures Treated With Flexible Elastic Nails Have Few Complications
Omar Atassi1, Philip B Fontenot1,2, Gennadiy Busel1
1Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and.
Insights
Flexible elastic nailing is a safe treatment for pediatric femoral shaft fractures, even unstable ones. This method showed no predictable complications based on fracture type or patient characteristics.
Area of Science:
- Orthopedic surgery
- Pediatric trauma care
- Biomedical engineering
Background:
- Pediatric femoral shaft fractures require effective treatment to minimize complications.
- Flexible elastic nailing is a common surgical technique for these fractures.
- Understanding factors predicting complications is crucial for optimal patient outcomes.
Purpose of the Study:
- To assess the complication rate of flexible elastic nailing in pediatric femoral shaft fractures.
- To identify fracture characteristics that may predict complications associated with this treatment.
Main Methods:
- A retrospective cohort study was conducted at two academic trauma centers.
- One hundred one pediatric femoral shaft fractures treated between 2006 and 2018 were analyzed.
- Data on fracture patterns, treatment, and outcomes, including complications, were collected.
Main Results:
- All 101 fractures achieved union without requiring revision for malunion.
- Only three patients (3%) experienced unplanned surgery, two for prominent implants and one for refracture.
- No patient, fracture, or treatment characteristics predicted complications or unplanned surgery, including "unstable" fracture patterns (P = 0.78).
Conclusions:
- Flexible elastic nailing is a safe and effective treatment for most pediatric femoral shaft fractures.
- The technique is suitable even for fractures previously considered "unstable."
- No specific characteristics were found to predict complications, suggesting broad applicability.
Objectives:
To determine our complication rate in pediatric femoral shaft fractures treated with flexible elastic nailing and to determine fracture characteristics that may predict complications.
Design:
Retrospective cohort study.
Setting:
One Level 1 and One Level 2 academic trauma centers.
Patients/Participants:
One hundred one pediatric femoral shaft fractures treated from 2006 to 2018.
Main Outcome Measurement:
Major and minor complications.
Results:
One hundred one femurs met inclusion criteria. The average age was 7 years (range 3-12 years). The average weight was 29.0 kg (range 16-55 kg). The average follow-up was 11 months (6-36 months). Ninety-three patients underwent elective implant removal at our institution. Fifty-one of the 101 (50%) fractures were "unstable" patterns. Ninety-three percent had implants that filled >80% of the canal (69 titanium and 32 stainless steel). Seventeen percent (18) had cast immobilization. All fractures went on to union. No patient required revision surgery for malunion as follows: 6 had coronal/sagittal malalignment >10 degrees, 3 had malrotation >15 degrees, and none had a leg length inequality >1 cm. Three patients had an unplanned surgery as follows: 2 for prominent implants and 1 for refracture after a second injury. There were no patient, fracture, or treatment characteristics that were predictive of complications or unplanned surgery, including "unstable" fractures (P = 0.78).
Conclusion:
Our study demonstrates that flexible elastic nailing can be safely used in most pediatric femoral shaft fractures, including those previously described as "unstable."
Level Of Evidence:
Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
