Titanium Elastic Intramedullary Nails Research Articles

Rotational control of various pediatric femur fractures stabilized with titanium elastic intramedullary nails.

This study investigated the torsional stability of transverse, oblique, spiral, butterfly, and comminuted pediatric femur fractures reduced with titanium elastic nails. Twenty-five fractures were created in synthetic analog pediatric femora (five of each fracture type); each fracture was reduced with two 4-mm-diameter titanium elastic nails. Each reduced femur was tested for rotational stability using an MTS. Angular displacements and torques were recorded, plotted, and regressed, and the slope (torsional stiffness) was determined; analysis of variance was performed between fracture groups and rotational testing direction. The oblique fracture pattern exhibited the greatest torsional stiffness in internal rotation, the spiral fracture pattern the greatest stiffness in external rotation. All reduced fracture patterns possessed a torsional stiffness statistically equal to or greater than the torsional stiffness of the transverse fracture pattern. These results suggest this method of internal fixation provides a consistent means of rotational stability for a variety of fracture patterns in a synthetic model.

Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them.

Flexible intramedullary nailing has become a popular method of fixation of pediatric femoral fractures. The authors analyzed their first 5-year experience with titanium elastic stable intra-medullary nailing, specifically to report the complications associated with this technique and to provide recommendations to avoid these complications. Seventy-eight children with 79 femoral fractures were treated by this method. Complications included pain/irritation at the insertion site (41), radiographic malunion (8), refracture (2), transient neurologic deficit (2), and superficial wound infection (2). Ten patients required reoperation prior to union. Malunion and/or loss of reduction requiring reoperation was strongly associated with the use of nails of mismatched diameters (odds ratio = 19.4) and comminution of more than 25% (odd ratio = 5.5). Pain at the insertion site was significantly associated with bent or prominent nail ends. Most complications are minor, and many are preventable. Surgeons should advance nail ends to lie against the supracondylar flare of the femur to avoid symptoms at the insertion site and should avoid implanting nails of two different diameters. Comminuted fractures should be monitored carefully and might benefit from additional immobilization.