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Published on: November 13, 2016
Flexible intramedullary nail fixation of pediatric femoral fractures
1Department of Surgery (Orthopaedics), University of Western Ontario, London, Canada.
Insights
Antegrade flexible intramedullary nailing is a safe and effective treatment for pediatric femoral shaft fractures in children aged 6-12. This operative approach offers rapid recovery and avoids complications associated with prolonged immobilization.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
Background:
- Pediatric femoral shaft fracture management is shifting towards operative interventions.
- Concerns exist regarding prolonged immobilization's negative effects and lengthy hospitalizations with traditional traction methods.
Purpose of the Study:
- To evaluate the safety and efficacy of antegrade flexible intramedullary nailing for pediatric femoral shaft fractures.
Main Methods:
- Retrospective review of 25 children treated with antegrade flexible intramedullary nailing.
- Assessment of union rates, malunions, limb length discrepancies, and proximal femoral morphology.
Main Results:
- No nonunions or significant malunions were observed.
- Minor, clinically insignificant variations in limb length and proximal femoral morphology were noted.
- No evidence of complete trochanteric growth arrest on radiographic follow-up.
Conclusions:
- Antegrade flexible intramedullary nailing is a safe and effective treatment option for pediatric femoral shaft fractures in children aged 6 to 12 years.
- This method facilitates quicker patient recovery and reintegration compared to traditional methods.
Abstract:
The management of pediatric femoral shaft fractures gradually has evolved toward a more operative approach in the past decade. This is because of a desire for more rapid recovery and reintegration of the patients, and a recognition that prolonged immobilization can have negative effects even in children. Economic pressures also favor a treatment that does not require as prolonged a hospitalization as that required with the traditional traction method. External fixation, compression plating, and intramedullary nailing all have been advocated. A retrospective review of the experience with antegrade flexible intramedullary nailing in 25 children was performed. No nonunions or significant malunions were seen. Followup evaluation of limb lengths and proximal femoral morphology showed minor variations of articulotrochanteric distance and neck shaft angle, none of which were clinically significant. Likewise, minor limb length discrepancies were measured (range, -11- +14 mm) with no consistent pattern of overgrowth noted. There was no evidence of a complete trochanteric growth arrest on radiographic followup. Flexible intramedullary nailing seems to be a safe and effective method for the treatment of femoral shaft fractures in the child between 6 and 12 years of age.
