Elastic stable intramedullary nailing for pediatric long bone fractures: experience with 175 fractures.
ABSTRACT To demonstrate the effectiveness of intramedullary fixation of displaced long bones shaft fractures in skeletally immature children using the elastic stable intramedullary nails.
The case records of 173 children who underwent fixation with titanium intramedulary nails because of long bones fractures were reviewed. The average age of the patients was 11.7 years, and mean follow-up was 41.3 months. There were 55 humeral, 42 forearm, 42 femoral and 36 tibial fractures. Subjective satisfaction was assessed.
All patients achieved complete healing at a mean of 7.5 weeks. Complications were recorded in 11 (6.3%) patients and included: one neuropraxia, six entry site skin irritations, two protrusions of the wires through the skin and two skin infections at the entry site. In a subjective measure of outcome at follow-up, 89% of patients were very satisﬁed and 11% satisﬁed; no patients reported their outcome as not satisﬁed. The implants were removed at a median time of six months from the index operation.
Elastic Stable Intra-medullary Nailing is the method of choice for the pediatrics patients, because it is minimaly invasive and shows very good functional and cosmetic results. It allows an early functional and cast-free follow-up with a quick pain reduction.
[Show abstract] [Hide abstract]
ABSTRACT: Pediatric closed femoral shaft fractures are commonly related to a good prognosis. There is no consensus on treatment. We aimed to evaluate the treatment, features, radiological findings and management strategies, creating an algorithm of treatment. Fifty-two simple femoral shaft fractures in children were retrospectively evaluated for age and gender distribution, side of the fracture, etiology of injuries, limb length discrepancy, range of knee and hip motion and parents satisfaction with a mean clinical and radiographic follow-up of 3 years and 6 months. Twenty-eight patients were treated with reduction and early hip spica cast while 24 patients were treated with external fixation (EF). Nearly 58 % of the cases were caused by traffic accidents and were predominantly male (61.5 %). Most of the fractures were of the middle femoral shaft (57.6 %). Muscle strength was normal (MRC scale) in all patients with no pain (NIPS and PRS scale). Knee and Hip range of motion were similar in both types of treatment. Patients treated with EF had shorter limb length discrepancy compared with SC. There were no reports of re-fracture. We found a higher familiar satisfaction in patients treated with EF. An algorithm for the management of femoral shaft fractures in the pediatric population is proposed. Results on the study population gave raise to a satisfactory clinical and radiological results.MUSCULOSKELETAL SURGERY 08/2013; DOI:10.1007/s12306-013-0299-3
[Show abstract] [Hide abstract]
ABSTRACT: Diaphyseal and metaphyseal fractures of the humerus are relatively frequent in children. The treatment is often conservative, even in the case of displaced fractures for the high rate of spontaneous recovery of these fractures. The limits of nonsurgical treatment and its applications as well as the type of surgical treatment are controversial issues in the literature. The aim of this study is to review a series of metaphyseal and diaphyseal fractures of the humerus treated with intramedullary osteosynthesis, to discuss the results obtained and the problems found, and to propose some parameters that should be taken into account to choose the most appropriate osteosynthesis. The retrospective study was performed on a group of 105 proximal and distal metaphyseal fractures and of displaced diaphyseal fractures of the humerus (excluding epiphyseal trauma, supracondylar fractures, and pathologic fractures) treated from 2001 to 2005. Out of a total of 105 patients, only 22 had fracture reduction under anesthesia, followed by intramedullary osteosynthesis; in 11 cases, intramedullary osteosynthesis was performed using Kirschner wires and in the remaining 11 elastic nails were used. In all treated patients, fracture healing was achieved. In the patients treated with Kirschner wires, no complications were observed, whereas in the patients treated with intramedullary nails, there were three cases with involvement of the skin and subcutaneous layers at the nail insertion site and one case of temporary paralysis of the radial nerve disappearing spontaneously after 2 months. Considering the results obtained and the low number of technique-related complications (low anesthesiologic and infectious risk), we can conclude that intramedullary osteosynthesis is a simple, safe, and rapid method suitable at any age in childhood. Level of evidence: level IV.Journal of pediatric orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America 05/2012; 21(4):300-4. DOI:10.1097/BPB.0b013e328353d96d · 0.66 Impact Factor