A clinical study of Ender nails fixation in femoral shaft fractures in children

Abstract

Background : Fracture of femoral shaft is fairly common in children and should be considered serious because of blood loss and potential shock that accompany the primary trauma. Surgical procedure allows early mobilization, rapid callus formation and rapid restoration of continuity of bone. Method : We studied 24 children with 24 femoral shaft fractures in age group 6-14 year (average 9.67 years). Eighteen fractures were in middle third, 4 in distal third and 2 in proximal third. Fifteen fractures were transverse, 4 oblique and 5 were spiral. Twenty-three cases were closed and one grade I compound. The injury surgery interval was 6 day. Mean hospital stay was 10.4 days. They were treated by closed reduction and Ender's nail fixation. Result : The minimum follow up was 6 months. The average time to clinical union and full weight bearing was 6.6 week (5 to 12 week); full movement was achieved in 9 weeks (6 to 15 weeks). One case of intraoperative perforation occurred. Two cases of nail protrusion and infection occurred. No cases of deep infection, delayed union, nonunion were seen. Seven cases had no limb length discrepancy. Thirteen cases had lengthening (max 9 mm mean 4.23mm), 4 cases had shorting (max 7mm mean 4.25mm). On the Flynn criteria 20 denoted excellent and 4 had satisfactory results. No poor results were seen. Conclusion : Healing in cases treated with Ender's nail can be with abundant callus attributed to non rigid fixation. This resulted in rapid fracture union and early return to few weight bearing while reducing hospital stay. Advantages that Ender nailing offers over other treatment modalities both consecutive as well as operative convinces us to recommend ender nailing in isolated femoral shaft fracture in children between 6-14 years.