Malunion following flexible intramedullary nails for tibial and femoral fractures in adolescents

D E Deakin,P Jain,C E Bache,H Winter

doi:10.1007/s11832-010-0300-8

D E Deakin, P Jain + Show 2 more

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https://doi.org/10.1007/s11832-010-0300-8

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Abstract

Flexible intramedullary nails (FIN) are increasingly used in the management of paediatric tibial and femoral fractures. Concerns have recently been raised regarding the use of FIN in older children. The aim of this study was to determine how effective FIN is in treating tibial and femoral fractures in adolescents. Patients aged 11years or older undergoing FIN for tibial and femoral fractures between 2003 and 2009 were identified. Radiographs and case notes were reviewed to identify complications. Thirty-five consecutive adolescent patients underwent FIN for tibial (n=21) and femoral fractures (n=15), with a mean age of 12.9years. The mean radiographic follow up was 29weeks. Sixty percent (60%, n=9) and 38% (n=9) of femoral and tibial fractures, respectively, malunited. Fracture severity was associated with increased malunion for both tibial and femoral fractures (P=0.046 and P=0.044, respectively). Two femoral fractures took longer than 20weeks to unite and seven tibial fractures took longer than 16weeks to unite. The higher than expected rates of malunion and delayed union in this study suggest that other treatments should be considered when treating adolescents with unstable tibial or femoral fractures.

Highlights

Flexible intramedullary nails (FIN) have been used increasingly since the 1980s for the management of paediatric tibial and femoral fractures [1]
Two femoral fractures took longer than 20 weeks to unite and seven tibial fractures took longer than 16 weeks to unite
The higher than expected rates of malunion and delayed union in this study suggest that other treatments should be considered when treating adolescents with unstable tibial or femoral fractures

Summary

Introduction

Flexible intramedullary nails (FIN) have been used increasingly since the 1980s for the management of paediatric tibial and femoral fractures [1]. Excellent results have been reported for FIN in the treatment of both tibial and femoral fractures in the general paediatric population [5,6,7,8]. Concerns have recently been raised regarding the use of FIN in older, heavier children and in unstable fracture configurations. Moroz et al reported a series of 234 femoral fractures treated with FIN from six separate institutions and demonstrated poorer outcomes for older children and for heavier children [10]. The use of FIN has recently been questioned for unstable fracture configurations, with comminution of greater than 25% being associated with malunion [12]. The aim of this study was to determine the complication rate of FIN used for the treatment of unstable tibial and femoral fractures in adolescents. We wanted to determine which factors were most important in predicting outcome

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