Titanium elastic nailing in pediatric femoral diaphyseal fractures in the age group of 5-16 years - A short term study.

Abstract

Management of femoral diaphyseal fracture in the age group of 5-16 years is controversial. The purpose of this study is to demonstrate the effectiveness of intramedullary fixation of femoral shaft fractures by using titanium elastic nailing system (TENS). Between April 2011 and April 2014, 40 pediatric patients (31 boys, 9 girls) aged 5-16 years with diaphyseal femoral fractures were treated by retrograde TENS fixation. Fractures were classified according to system of Winquest and Hansen as Grade-I (n=18), Grade-II (n=10), Grade-III (n=7) and compound fractures according to the Gustilo and Anderson's classification Grade-I (n=3), Grade-II (n=2). The final results were evaluated by using Flynn's criteria. The mean duration of follow-up was 21 months (range 3-39 months). All fractures were radiologically united with grade 3 callus formation at 8-10 weeks period (mean 9 weeks) and full weight bearing was possible in a mean time of 9.5 weeks. According to Flynn's criteria, excellent result was found in 33 patients (82.5%) and satisfactory in 7 patients (17.5%). Limb lengthening was noticed in 6 cases, varus mal-alignment was in 4 cases and rotational mal-alignment was seen in 3 cases. Peri-operative difficulties encountered were failure of closed reduction in 4 cases and cork screwing of nails in 2 cases. TENS is a safe and effective method for the treatment of pediatric femoral shaft fractures, because it is minimally invasive, relatively easy to use and shows very good functional and cosmetic results.