Intramedullary nails for pediatric diaphyseal femur fractures in older, heavier children: Early results

Richard A K Reynolds,Julie E Legakis,Ronald Thomas,Theddy F Slongo,Jean-Michel Clavert,James B Hunter

doi:10.1007/s11832-012-0404-4

Abstract

A common treatment for pediatric femur fractures is intramedullary nail (IMN) insertion. Elastic stable intramedullary nails (ESINs) are often used for these procedures in heavier patients, but the potential for complications and malunion is greater. We describe here a rigid IMN specifically designed for adolescents, the adolescent lateral entry femoral nail (ALFN). The purpose of this study was to compare the recovery and complications for patients treated with ESINs to those treated with the ALFN. Our study design was a retrospective cohort study. We performed a review of medical records of 22 children ages 10-17 requiring surgical fixation of a femur fracture for a 2½-year period. Patients selected for the study had traumatic diaphyseal femur fractures and were treated with ESINs without end-caps or ALFNs. Our analyses evaluated injury, surgical, and outcome information for all patients. Twenty-two patients were eligible for inclusion and were divided into two groups according to their treatment: the ESIN group with 7 patients and the ALFN group with 15 patients. We then performed a comparison of complications and recovery for these patients. The mean time to full weight-bearing was significantly less for the ALFN group (4.1weeks; SD, 2.2), than the ESIN group (9.4weeks; SD 3.9). There was no statistical difference in the incidence of major or minor complications. Older, heavier pediatric patients treated for femur fracture with ALFNs had a shorter recovery time than similar patients treated with ESINs. However, the outcomes for both groups were satisfactory.

Highlights

Treatments for pediatric femoral fractures usually result in satisfactory outcomes
We describe here a rigid intramedullary nail (IMN) designed for adolescents, the adolescent lateral entry femoral nail (ALFN)
The purpose of this study was to compare the recovery and complications for patients treated with Elastic stable intramedullary nails (ESINs) to those treated with the ALFN

Summary

Introduction

Treatments for pediatric femoral fractures usually result in satisfactory outcomes. The very young often undergo non-surgical management consisting of a spica cast [1, 2]. Surgical management of the fracture may be indicated and includes retrograde insertion of ESINs, open reduction and plate fixation, submuscular bridge plating, external fixation, and antegrade trochanteric entry nails [1, 3,4,5]. In recent years there has been a decline in the use of spica casting in children 6 years and older, with a concomitant increase in use of ESINs for the same age group, likely because when intramedullary nailing first gained popularity in North America, there were no satisfactory rigid nails available for children or adolescents. ESINs are the standard of care for most uncomplicated pediatric femoral fractures, they do have limitations

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