Abstract
BackgroundFlexible intramedullary nailing has emerged as an accepted procedure for paediatric femoral fractures. Present indications include all patients with femoral shaft fractures and open physis. Despite its excellent reported results, orthopaedic surgeons remain divided in opinion regarding its usefulness and the best material used for nails. We thus undertook a retrospective study of paediatric femoral fractures treated with titanium or stainless steel flexible nails at our institute with a minimum of 5 years follow up.Material and methodsWe included 73 femoral shaft fractures in 69 patients treated with retrograde flexible intramedullary nailing with a minimum follow up of 5 years. Final limb length discrepancy and any angular or rotational deformities were determined.ResultsMean age at final follow up was 15.5 years (10-21 years). Mean follow up was 7.16 years (5.0-8.6 years). Titanium and stainless steel nails were used in 43 and 30 cases respectively. There were 51 midshaft, 17 proximal, and 5 distal fractures.All fractures united at an average of 11 weeks but asymptomatic malalignment and LLD were seen in 19% and 58% fractures respectively. LLD ranged from -3 cm to 1.5 cm. Other complications included superficial infection(2), proximal migration of nail(3), irritation at nail insertion site(5) and penetration of femoral neck with nail tip(1). There were 59 excellent, 10 satisfactory and 4 poor results.ConclusionFlexible intramedullary nailing is reliable and safe for treating paediatric femoral shaft fractures. It is relatively free of serious complications despite asymptomatic malalignment and LLD in significant percentage of fractures.
Highlights
After acute infections, trauma is a leading cause of morbidity and mortality in children [1,2]
Flexible intramedullary nailing is reliable and safe for treating paediatric femoral shaft fractures. It is relatively free of serious complications despite asymptomatic malalignment and LLD in significant percentage of fractures
Flexible intramedullary nailing introduced for femoral fractures by Nancy group in 1982 [22], has become popular with many orthopaedic surgeons and remains the treatment of choice for these fractures at our institute due to its favourable results and lack of serious complications
Summary
Trauma is a leading cause of morbidity and mortality in children [1,2]. Accounting for less than 2% of all orthopaedic injuries in children [3], femoral fractures have a significant impact on the patient and their family network, and on regional trauma resources [4,5]. These fractures have been managed with wide variety of methods in past. Flexible intramedullary nailing introduced for femoral fractures by Nancy group in 1982 [22], has become popular with many orthopaedic surgeons and remains the treatment of choice for these fractures at our institute due to its favourable results and lack of serious complications.
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