English

Abstract

INTRODUCTION: Femoral shaft fractures are common fractures in paediatric age group. There are various methods to treat them. Elastic stable intramedullary nailing is one of them and an established and reliable method for treating these fractures. Ideal treatment of femoral shaft fractures in the age group of 5 to 14 years is still a matter of debate as no consensus has been achieved till now. We have done a study to know whether elastic stable intramedullary nails can be used reliably in this age group. So, purpose of the present study is to evaluate the outcome of titanium and stainless steel elastic nail in paediatric femoral fractures in 5-14 years of age group. METHODS: A group of forty two children with femoral fractures that were treated with elastic nails (which includes both titanium and stainless steel nails- both nail types were of similar design) and outcome was evaluated. Twenty children (16 boys, four girls) in the age group of 5-14 years (average 9.3 years) with femoral shaft fractures (16 closed, two Grade- I and two Grade- II compound) were stabilized with Titanium Elastic Nail (TEN), while twenty-two (16 boys, six girls) in the age group of 5-14 years (average 9.1 years) with femoral shaft fractures (18 closed, two Grade- I and two Grade- II compound) were stabilized with Stainless Steel Elastic Nail (SSEN) between June 2009 and October 2011. A familiar retrograde insertion technique was used. Major complications were defined as malunion with sagittal angulation of >15° and coronal angulation of >10°, nail irritation requiring revision surgery, infection, delayed union, and rod breakage. Minor complications were defined as nail irritation or superficial infection not requiring surgery. RESULTS: Radiological union was achieved in all cases in a mean time of 7.7 weeks (6-12 weeks) in TEN groups while that took 7.9 weeks in SSEN group. Full weight bearing was possible in a mean time of 7.7 weeks (6-12 weeks) in TEN groups and a mean of 7.9 weeks in SSEN group. All cases were assessed by Flynn classification method and outcome scoring system. We noted excellent results in 26 cases (63%), satisfactory results in 14 cases (33%), while poor result in 2 cases (4%) in this study. There were six minor complications such as one superficial cellulitis and one case of implant-related pain and four cases of skin irritation at the nail tip (18%). Two cases deep infection (both cases are associated with grade II open fractures) requiring prolonged treatment with antibiotic were seen in each group. 2 case of shortening >1cm (9%) but 100 (9%) was seen with stain less steel elastic nail. CONCLUSIONS: Our results indicate that that elastic nail can be effectively used to treat fractures of diaphysis of femur in children. It can also be used very effectively in open fractures (up to Gustilo &Anderson grade II), in comminuted fractures (up to Winquist & Hansen type II) and in a multisystem injured patient.