Flexible Nailing Research Articles

Comparative Analysis of Surgical Techniques for Pediatric Diaphyseal Forearm Fractures: A Focus on Titanium Flexible Nails versus Plates and Screws

Comparative Analysis of Surgical Techniques for Pediatric Diaphyseal Forearm Fractures: A Focus on Titanium Flexible Nails versus Plates and Screws

Elastic nail versus plate for treatment of single close fracture of femur shaft

This study aims to describe the outcome of pediatric flexible nails versus plates for the treatment of femur fracture. We reviewed the medical records of 28 femur fractures in children treated with flexible nail insertion and 26 children treated with plate fixation from January 2017 to December 2019. The mean age of the children was 8.88 ± 1.86 years. Data were obtained from patient charts. Union of bones was found in all the operated children, 28 (51.9%) of the group flexible nails, while no union was found in 3 (5.6%) of the group plate with screws. Delay union was found in 5 (9.3%) of the plate with screws, while in the group of flexible nails was in 2 (3.7%). Malrotation was found in 2 (3.7%) of the flexible nails and in 1 (1.9%) in the plate and screw. Bursa was found only in the flexible nails with 7 (13%) (p = 0.007). Re-fracture was found only in the group of plates with screws with 5 (9.3%) (p = 0.021). The limbs were shortened only in 1 (1.9%) patient with flexible nails. Superficial infection was high in the group plate with screws group 4 (7.4%). Deep infection was found to be high among 3 (5.6%) of the group plate & screw. We conclude that flexible intramedullary nail fixation of fracture shaft femur in children is a very acceptable way of treatment and is associated with minimal complications.

Treatment of Pediatric Femoral Shaft Fractures by Using Plating Vs Flexible Nail Comparative Study

Treatment of Pediatric Femoral Shaft Fractures by Using Plating Vs Flexible Nail Comparative Study

Outcome of Flexible Intramedullary Nailing versus Plating in Treatment of Diaphyseal Femur Fractures in Paediatrics: Systematic Review and Meta-analysis

Abstract Background Pediatric femoral fractures are the most the common long bone fracture in children, with one third of these occurring between ages 5 to 12. These injuries are usually the result of road traffic accidents, sports and non-accidental injury. Different modalities exist for managing these fractures, often stratified according to the age of the patient. Aim of the Work The aim of this work is to provide a complete overview of the optimal surgical treatment of diaphyseal femur fractures in children by evaluating and comparing the clinical and functional outcomes of flexible intramedullary nailing versus plating for such fractures. Patients and Methods This review followed the Cochrane Handbook's standard methodology and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- analyses (PRISMA) statement guidelines. Result In patients undergoing flexible nailing, the surgical variable data found this treatment modality to be superior in terms of certain operative features: shorter operative duration times (p = 0.00001), smaller volumes of estimated blood loss (p = 0.00001). There was no difference regarding length of hostital stay (p = 0.59). This suggests that flexible nailing may offer increased safety to patients in terms of duration of anesthesia, volume of blood loss, and cost of surgery when compared to plating. However, Secondary outcome analysis also found a statistically significant increased risk of malunion (p = 0.002) and metalwork irritation (p = 0.00001) when using FIN compared to plating techniques. There was no difference regarding risk of infection (p = 0.53) and developing leg length discrepancy (p = 0.44). Conclusion Options for stabilization and fixation in this age group include flexible nailing, plating (open or sub-muscular), external fixation, or hybrid techniques.

Comparing the Outcomes of Titanium and Stainless Steel Flexible Nails in Repairing Pediatric Long Bone Fractures.

Traditionally, pediatric femoral fracture treatment favored conservative methods, relying on casting and the inherent bone remodeling ability in immature bones. Surgical intervention was deferred until age 6, as nonoperative approaches often resulted in complications. Titanium elastic nailing (TENS) emerged as an effective treatment for diaphyseal femoral fractures in ages 6 to 16. However, the choice between TENS and stainless steel elastic nailing (SSENS) remains debated due to inconsistent findings. This study aimed to evaluate the effectiveness of both nailing systems in pediatric long bone fractures. A retrospective chart review at William Beaumont Hospital Royal Oak included 83 patients aged 6 to 16 treated with TENS or SSENS between January 2011 and January 2021. Data collected encompassed nail related issues, time to fracture union, full weight bearing, and nail removal. In the TENS group (n=29), the average age was 8.8±2.4 years, and the average BMI was 17.2±3.4. The SSENS group (n=54) had an average age of 9.3±2.7 and an average BMI of 19.7±8.4. Time to fracture union for TENS was 93.8±60.5 days, while SSENS was 82.2±40.0 days. This study found no statistically significant differences in nail-related complications, time to fracture union, full weight bearing, or nail removal between TENS and SSENS in pediatric long bone fractures. The choice between these systems should be based on individual circumstances. Limitations include a small sample size and the study's retrospective nature.

Instability, non-union, and subsequent failure of flexible nails: Takeaways from the complication

Instability, non-union, and subsequent failure of flexible nails: Takeaways from the complication

Is Elastic Stable Intramedullary Nailing a Viable Treatment Option for Diaphyseal Fractures of the Humerus in Adults? A 29-case Series Prospective Study.

Humerus shaft fractures are common in orthopaedic practice. The emphasis in treatment has shifted from prolonged immobilisation to early mobilisation and internal fixation when needed for a quicker return to normal function. Internal fixation methods include plate osteosynthesis and intramedullary nailing. This study specifically evaluated the effectiveness of flexible intramedullary nails in treating diaphyseal humeral fractures. Between April 2007 and January 2010, Alexandria University Hospital treated 29 patients (21 males, 8 females) with diaphyseal humeral fractures. Treatment involved closed reduction and percutaneous fixation using two flexible nails. Patients, aged 17 to 65 with a mean age of 32, were included if they did not have pathological fractures, were above 16 years old, and were medically suitable. Causes included pedestrian vehicle accidents (17 cases) and falls or sports-related activities (12 cases). Surgical intervention occurred 1 to 8 days after the injury. Between April 2007 and January 2010, Alexandria University Hospital treated 29 patients (21 males, 8 females) for diaphyseal humeral fractures using closed reduction and percutaneous fixation with two flexible nails. Patients, aged 17 to 65, were monitored for an average of 18 months. Radiographic assessments showed complete union in nineteen fractures within 13 to 21 weeks. One patient experienced non-union but was successfully treated with bone grafting and plating. There were no significant intraoperative complications. Notably, four patients with preoperative radial nerve injuries recovered within 6 to 8 weeks. Evaluation using the Stewart and Hundley Scoring technique showed excellent outcomes for 60% of patients, good outcomes for 30%, fair outcomes for 5%, and poor outcomes for 5%. 1.The Elastic Stable Intramedullary Nailing (ESIN) technique shows promise in the treatment of humeral shaft fractures. 2. However, the success of treatment may depend on various factors, including patient age, fracture characteristics, and the presence of complications such as open fractures and radial nerve palsy. 3. Careful consideration of these factors is necessary when selecting a treatment approach for humeral shaft fractures.

Flexible Intramedullary Nail Placement in Pediatric Humerus Fractures.

Flexible intramedullary nailing is an effective method of stabilization in pediatric patients with a humeral shaft fracture when surgery is indicated1-3. Although these fractures are most often treated nonoperatively, operative indications include open fractures, bilateral injuries, compartment syndrome, pathologic fractures, neurovascular compromise, unacceptable alignment after attempted nonoperative treatment, and ipsilateral upper-extremity injuries4. The current literature on flexible intramedullary nailing of the pediatric humeral shaft lacks concise descriptions of available entry points, which directly affect the subsequent technique, and of pertinent pediatric-specific anatomy. Thus, the present article focuses on these entry points in the pediatric patient. Various entry points are available for the insertion of flexible nails into the humeral shaft. A surgeon must initially decide whether the patient and fracture characteristics are best suited for anterograde versus retrograde insertion. This choice typically depends on several fracture and patient-related characteristics. The passage of flexible intramedullary nails has been well described; thus, the present article will place special emphasis on the available proximal and distal entry points and pediatric-specific anatomy5-10. For diaphyseal fractures, we prefer dual distal lateral entry points with the nails advanced retrograde in a C-S configuration whenever possible, given the risks associated with proximal lateral entry (e.g., damage to the axillary nerve) or distal medial entry (e.g., damage to the ulnar nerve or nail prominence). A distal posterior supracondylar entry point is also possible but requires additional preoperative planning with regard to patient positioning, a more proximal entry point to avoid impingement of the olecranon on the nail in extension, and avoidance of the ulnar nerve. The substantial potential for remodeling in pediatric patients permits nonoperative treatment of humeral fractures if specific age-related criteria for angulation and displacement are met. Generally accepted tolerances for nonoperative angulation and displacement are as follows: for patients <5 years old, ≤70° angulation and up to 100% displacement; for patients 5 to 12 years old, 40° to 70° angulation; and for patients >12 years old, ≤40° angulation and 50% apposition4. The use of flexible nails is often preferred because of the healing potential of pediatric humeral shaft fractures, the ability of flexible nails to tolerate nonrigid fixation until osseous bridging occurs, the ability of the surgeon to avoid exposure of neurologic structures during surgery, and the benefit of avoiding physeal disruption. These factors make flexible nails a favorable option when compared with plate osteosynthesis or rigid intramedullary nailing. When indicated, the use of flexible intramedullary nails in pediatric humeral fractures has been associated with high rates of union, good functional outcomes, early range of motion, and an acceptably low rate of complications2. Be familiar with the technical details associated with all available entry points.Avoid damage to key neurologic structures around the proximal and distal humerus.Minimize the opportunity for symptomatic hardware.Optimize the biomechanics through flexible nail positioning at the fracture site. FIN = flexible intramedullary nailingEBL = estimated blood lossf/u = follow-upIM = intramedullaryMRI = magnetic resonance imagingOR = operating roomPT = physical therapyROM = range of motion.

The use of flexible nails in the treatment of paediatric long bone fractures: Experience at a level one paediatric trauma centre, a cohort study

IntroductionFractures occur in children at an incidence only surpassed by women >85 years and account for 25 % of paediatric injuries. Over the last three decades, there has been a trend towards operative management of children's fractures including utilisation of flexible nails as popularised by the Nancy group in the 1980s. Between 5 and 11 % of paediatric forearm fractures are now fixed in this manner with complication rates of 12–42 %. This study shares the experience of a paediatric level one major trauma centre using this technique in managing long bone fractures in children. Methods and materialsThis retrospective cohort study comprises a sequential series of 109 cases (71 children) of upper and lower limb fractures in children (aged 16 years and below) who underwent fracture fixation using flexible intramedullary nails between 1st April 2015 and 31st March 2019. Radiological and clinical outcomes and complications were assessed. ResultsNinety-three cases (10 in the lower limb, 83 in the upper limb) satisfied the inclusion criteria in 57 children with a mean age of 8.6 years. All cases were successfully reduced intra-operatively and 92 (98.9 %) achieved union. Taking into account all complications in the upper and lower limb, the overall complication rate is 30.1 % (28 cases) with the vast majority (13 cases, 46.4 %) occurring in the upper limb due to prominence of metalwork prompting early removal. ConclusionsThis study has shown flexible intramedullary nailing to perform well with good stabilisation of a wide variety of paediatric long bone fractures with restoration of bone alignment, satisfactory outcomes with good union rates and a return to normal function. The technique is also safe and in the upper limb can be performed as day-case surgery by a generalist orthopaedic surgeon. Although the overall complication rate is not insignificant, major complications are rare.

COMPARAÇÃO ENTRE OS MÉTODOS DE ESTABILIZAÇÃO DAS FRATURAS DIAFISÁRIAS DO FÊMUR NO ESQUELETO IMATURO, ENTRE HASTE FLEXÍVEIS E FIXADOR EXTERNO: REVISÃO SISTEMÁTICA E METANÁLISE

ABSTRACT Flexible intramedullary nailing and external fixation have become the main methods to surgically treat femur fractures in children. This study aimed to search the current literature and evaluate the clinical and radiographic results of surgical treatment by comparing these methods and investigating their associated complications. This systematic review was carried out following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) recommendations. Searches were carried out on the PubMed, Embase, and Web of Science databases. The search for journals in these databases was carried out from January 2023 to August 2023, retrieving 695 studies. This systematic review included 11 articles, which encompassed 718 patients who underwent surgical external fixation and flexible nailing. The most frequently observed complications referred to late or malunion, superficial and deep infections, skin irritation, angular deformity, and length discrepancy between lower limbs. Both methods of stabilization of pediatric femoral fractures can provide good clinical and radiographic results. However, the choice of treatment with flexible nails is certainly more valid and has greater acceptance than external fixation. Level of Evidence III, Systematic Review .

Management of unicameral bone cysts by intramedullary flexible nails: a series of 18 children

Abstract Introduction The intracystic injection of methylprednisolone acetate, curettage with bone grafting, osteoinductive treatments employing demineralized bone matrix, and intramedullary fixation with flexible nails are being used to treat unicameral bone cysts (UBC) in children. The purpose of this study was to assess the functional results of elastic stable intramedullary nails for symptomatic UBC with or without a fracture. Methods From March 2012 to March 2022, 18 patients with UBC were treated with intramedullary flexible nails. Pathological fractures were present at the cyst site in 6 individuals. 12 patients had discomfort and swelling in the afflicted extremity. Cysts were found in the humerus in 13 (72%) patients and the femur in 5 (28%) cases. The average age of the patient at the time of surgery was 7.8 (6–12 years), and the average follow-up period was 16 months. The Capanna et al. criteria were used to do the radiographic evaluation. Results According to radiological evaluation by Capanna et al., 5 cysts healed completely (Stage I), 5 cysts healed with residual radiolucent areas visible on radiographs that were less than 3 cm in size (Stage II), and 7 cysts healed with residual radiolucent areas that were visible on radiographs that were larger than 3 cm in size (Stage III). An infection at the surgery site affected one patient. A 12 (60%) patients had their implants removed. Conclusion Elastic stable intramedullary nailing promotes early stabilization, enables early mobilization, eliminates the need for a plaster cast, and reduces the occurrence of a pathological fracture with early return to functional activity.

An Evaluation of the Efficacy of Flexible Nailing in the Management of Diaphyseal Forearm Fractures: A Prospective Study in Rural India's Healthcare Settings

Introduction: High-speed accidents and trauma are becoming increasingly common and often result in forearm fractures in developing countries and even rural populations are not immune to such injuries. To address this issue, there has been a growing trend towards using flexible intramedullary nailing systems, such as the Titanium Elastic Nailing System (TENS). Methodology: This prospective study conducted at PES Institute of Medical Sciences and Research, Kuppam India, between June 2019 and March 2023 after receiving institutional ethical approval, patients with diaphyseal fractures of the forearm were treated with TENS, after their consent and, then followed up at 1st, 3rd, and 6th months post-operatively using Daruwalla's Clinical criteria. Result: The study involved 300 patients, with a male predominance (60%) and most common age group of 11-20 years old (26.7%) involving right forearm (63.3%), at middle third (76.7%) with transverse (80%) and closed (86.7%) nature. The leading cause was road traffic accidents (50%). At the first month, 86.7% had fair outcomes according to Daruwalla's grading, with 40% showing excellent outcomes by the 6th month. Over time, the proportion of patients with good (46.7%) and excellent (40%) outcomes increased, while fair and poor outcomes decreased (13.3%, 0%) Conclusion: TENS has shown efficacy in treating forearm fractures. Positive trends in clinical grading were seen, with a majority of patients achieving fair to excellent outcomes by the 6th month post-operative follow-up. These results support TENS, even in rural settings with limited resources, as a viable alternative to plate osteosynthesis. Keywords: Intramedullary Nailing, Forearm Injury, Fracture

Complications in operatively managed pediatric femoral shaft fractures

Objectives: Despite being the strongest long bone in the body, femur shaft fractures (FSFs) remain steadily prevalent in Saudi Arabia and globally. The goal of treatment is to achieve fracture healing with the least complications. Therefore, this study intended to determine the complications in pediatric FSFs, which were operatively managed. Methods: This study is a retrospective analysis of 76 pediatric FSFs. The inclusion criteria included age ≤14 years, FSFs operatively treated in the study center, at least one-year follow-up, and admission between January 1, 2012, and January 1, 2020. Pathological fractures and patients with neuromuscular or syndromic conditions were excluded from the study. Results: Seventy-two patients (81.9% boys, mean age 8.1 years) with 76 FSFs were analyzed. Most injuries were from motor vehicle accidents (41.6%), falls (29.1%), and pedestrian trauma (15.2%). Titanium was used in 47 (61.8%). Plating was used in 16 (21%), rigid nails in eight (10.5%), and hip spica under general anesthesia in five (6.5%). Out of those 76 fractures, 17 had developed complications. These complications varied in their significance, including limb length discrepancy (LLD) (five), non-union (three), 15° angulation (three), skin irritation due to cast soiling (two), skin swelling due to prominent flexible nail (one), surgical site infection (one), osteomyelitis (one). LLD was significantly associated with increased weight, fracture pattern, non-union, and definitive fixation time. Conclusion: Overall complications in operatively treated pediatric FSFs were low and not disabling. LLD was the most common with a significant association with increased weight, unstable fracture pattern, non-union, and definitive fixation time.

Results of the Pediatric Shaft Femur Fracture Treated with Closed Rigid Lateral Trochanteric Entry Intramedullary Nail in North Indian Population

Objectives The femoral shaft fractures constitute 1.6% of the pediatric fractures. Intramedullary nailing is a common mode of fixation in older children and adolescents. The rigid intramedullary locking nail is a preferred choice over flexible nails in overweight patients and children older than 11 years of age. The adolescent age group with skeletal immaturity deserves special attention from the surgeons because of grave complications like avascular necrosis of the femur head and angular deformities. The aim of this study is to report the outcome of an adolescent femur shaft fracture treated with a rigid intramedullary interlocking nail in North Indian patients. Material and Methods This is a retrospective analysis performed by retrieving records of 19 patients. Patients with open fractures, polytrauma and neurovascular injuries were excluded. The preoperative and post-operative radiographic orthogonal views were analyzed to assess parameters like alignment, union and avascular necrosis (AVN). Results The mean age was 12.3 years. The mean follow-up was 1.5 years. The average time for union was 8 weeks. All the fractures were united in an acceptable alignment and rotation. There was no avascular necrosis, angular deformity and infection. The mean femur length discrepancy was 7 mm. Conclusion The rigid intramedullary interlocking nail is a valuable option for the fixation of femoral shaft fractures in an adolescent age group with a good union rate and minimal complications.

Efficacy of Single Titanium Elastic Nail in the Treatment of Child Femur Fractures.

Femoral shaft fractures in childhood constitute an important part of emergency visits to orthopedic clinics. The aim of this study was to investigate the efficacy and reliability of a method in the treatment of simple fractures in the middle of the femoral diaphysis in patients with multiple injuries or in the treatment of cases with a medullary canal that is too narrow for two nails, with a single stretch nail thicker than half the diameter of the canal. Between July 2002 and November 2006, examinations were made of 11 femoral fractures in 11 patients who were admitted to the pediatric emergency department of Tepecik Training and Research Hospital with a diagnosis of femoral fracture and who were hospitalized and treated with a single flexible intramedullary titanium nail. In the follow-up, no problem was found in terms of union and length difference in any of the cases, except for a10º varus deformity present after surgery in one case. Elastic intramedullary nailing is an effective method in the treatment of simple femoral fractures in children. A single elastic nail provides adequate stability following open reduction with minimal incision in patients whose short operating time must be kept short such as those with head trauma, thoracic trauma, or intra-abdominal pathology, or patients with a narrow medullary canal where two flexible nails cannot pass. We think that it is a feasible method because it causes minimal soft tissue damage.

Antegrade Flexible Nailing for Pediatric Metaphyseal-diaphyseal Junction Distal Radius Fracture, is it Safe?

Fractures involving the distal radius metaphyseal-diaphyseal junction (MDJ) present a unique challenge for pediatric orthopedic surgeons. These fractures are too proximal for percutaneous K -wire fixation and too distal for retrograde flexible nailing. The purpose of this study was to: (1) determine the safety of a described antegrade approach from the posterior interosseous nerve (PIN); (2) assess the efficacy of antegrade nailing in cases of distal MDJ fractures; and (3) describe a standardized lateral approach to the proximal radius. A cadaveric study was performed using 10 adult forearms. Anterograde flexinail was introduced at the proximal radius based on the described "safe zone". Distal MDJ fractures were created using osteotomes. We evaluated the distance between the entry point to the PIN in addition to the quality of the reduction for the fracture. The average distance between the entry point and piercing instrument to the PIN was 5.4 cm (range: 4.7 to 6.0 cm). When grouped based on sex, the average distance was significantly further for males (5.8 cm, range: 5.2 to 6.0 cm) versus females (4.9 cm, range: 4.7 to 5.2 cm), P =0.004. Fracture reduction was not maintained after the introduction of the antegrade flexible nail across the fracture site. For all specimens, >25% displacement was seen on the anterior-posterior imaging. Our modified lateral approach to the starting point in the proximal radius is safe as long as the entry point for antegrade flexible nailing stays proximal to the radial tuberosity during the lateral approach to the proximal radius while the elbow is flexed and the forearm pronated.

Flexible Titanium Intramedullary Nail Displacement After Magnetic Resonance Imaging.

A previously healthy 7-year-old boy presented with midshaft radius and ulna malunion after 8 weeks of nonsurgical treatment. He underwent open reduction and internal fixation of both bones with titanium alloy nails and was placed in a long arm cast. Four weeks after surgery, the patient underwent sedated brain MRI and woke up from anesthesia with elbow pain. On cast removal, the ulnar flexible nail was noted to have displaced proximally by 1.5 cm. Despite meeting American Society for Testing and Materials standards, untethered titanium orthopaedic implants are at risk of clinically significant displacement in the early postoperative period.

Clinical outcome of femoral diaphyseal fractures in adults treated with open verses closed interlocking nail

BACKGROUND &amp; OBJECTIVE: There are different methods for treatment of the long bone fractures, including femoral diaphyseal fractures, ranging from closed intramedullary nail, open intramedullary nail to flexible nail, plating, and external fixator in open type 3 B and 3C fractures. The aim of this study was to compare the functional outcome of open versus closed techniques in treating femoral diaphyseal fractures in skeletally mature adults.&#x0D; METHODOLOGY: A simple observational study was conducted at the Department of Orthopedics, Allied Hospital Faisalabad, from January 2018 to January 2020 with a total of 60 skeletally mature patients with mean age 38.4+1.2 who fulfilled the inclusion criteria were operated, and five patients lost in follow-up. Group A consisted of 27 patients (18 males and 9 females) who were operated with closed interlocking technique. Group B consisted of 28 patients (12 males and 16 females) who were operated with open technique. Both groups were followed prospectively for two years to evaluate the outcome. T-test was used for statistical analysis.&#x0D; RESULTS: The rate of union in group A was better than in group B. Patients in group A had a reunion 1.99±0.86 weeks earlier than group B a significant difference between the two groups with p&lt;0.001. Nonunion occurred in 02(7.40%) patients of group A and 03(10.71%) patients of group B. Only 01 (3.7%) patient from group A and 02 (7.40%) patient of group B suffered from deep infections.&#x0D; CONCLUSION: Closed interlocking for femoral diaphyseal fractures provides earlier reunion of the bone and should be considered the treatment of choice. In case of lack of technical availabilities, open interlocking should be considered as a suitable option.

Canal Fill of the Forearm Bones When Placing Intramedullary Nails in the Pediatric and Adolescent Populations.

In the lower extremity, studies have suggested an optimal nail diameter to medullary canal diameter (ND/MCD) ratio to minimize postoperative complications. The goal of this study was to determine whether a correlation exists between the occurrence of complications, angulation, and range of motion and the ratio of the ND/MCD in the upper extremity. A total of 85 radius and ulna fractures treated with flexible intramedullary nails had ND/MCD ratios measured. Random-effects models were developed to determine the association between complications and ND/MCD ratio, angulation and ND/MCD ratio, and range of motion and ND/MCD ratio. The results were reported for unadjusted models and adjusted models. Of the 85 forearm fractures treated with intramedullary nailing, there were 3 complications. The average follow-up was 6 months. The ND/MCD ratios were categorized as <0.50, 0.50 to 0.59, and ≥0.60. There was not a significant association between the different ratios and angulation, or risk of complication. There was an association between the ND/MCD ratio ≥0.60 and decreased pronation of -1.58° (-2.77° to -0.38°) and supination of -2.68° (-4.91° to -0.46°) (P < .05). This study found that there was not an association between the nail to canal diameter ratio and postoperative angulation in forearm fractures treated with flexible intramedullary nails. When choosing a flexible nail for forearm fractures, there does not appear to be an optimal ratio; it is therefore reasonable to use the ND that passes more easily.

Femoral lengthening using limb reconstruction system augmented with only one antegrade flexible nail in children: early results.

Several techniques have been described for decreasing the duration of external fixator use, augmenting stability, and minimizing complications. The purpose of the present study was to evaluate the clinical results and complications of femoral lengthening procedures using the Limb Reconstruction System (LRS) in combination with a single antegrade flexible intramedullary nail (FIN). Femoral lengthening with LRS and FIN was applied to 14 patients (aged 6-16 years) between 2017 and 2021. The etiology was a congenital femoral deficiency in 12 patients and post-traumatic growth arrest in two. A single nail was inserted antegradely through the trochanteric apophysis in each patient. Radiographs and medical records of the patients were assessed retrospectively. The mean lengthening achieved was 4.8 ± 1.0 cm. The mean duration of external fixation was 181 days (range 139-248 days) and the mean healing index was 39.6 ± 12.1 days/cm. The mean values of mechanical medial proximal tibial angle, mechanical lateral distal tibial angle, mechanical lateral proximal femoral angle, and mechanical lateral distal femoral angle were within the normal range at the last follow-up. Seven of the 14 cases had a regenerate deformity that caused a displacement of more than 2 mm in the mechanical axis deviation, none of them was greater than 10 mm and considered clinically insignificant. Fracture was seen in two limbs with regenerate deformity. This study suggests that LRS in combination with only one FIN may be an effective alternative for femoral lengthening, with acceptable complication rates.