"Unstable" Pediatric Femoral Shaft Fractures Treated With Flexible Elastic Nails Have Few Complications.

Abstract

OBJECTIVES:

To determine our complication rate in pediatric femoral shaft fractures treated with flexible elastic nailing and to determine fracture characteristics that may predict complications.

DESIGN:

Retrospective cohort study.

SETTING:

One Level 1 and One Level 2 academic trauma centers.

PATIENTS/PARTICIPANTS:

One hundred one pediatric femoral shaft fractures treated from 2006 to 2018.

MAIN OUTCOME MEASUREMENT:

Major and minor complications.

RESULTS:

One hundred one femurs met inclusion criteria. The average age was 7 years (range 3-12 years). The average weight was 29.0 kg (range 16-55 kg). The average follow-up was 11 months (6-36 months). Ninety-three patients underwent elective implant removal at our institution. Fifty-one of the 101 (50%) fractures were "unstable" patterns. Ninety-three percent had implants that filled >80% of the canal (69 titanium and 32 stainless steel). Seventeen percent (18) had cast immobilization. All fractures went on to union. No patient required revision surgery for malunion as follows: 6 had coronal/sagittal malalignment >10 degrees, 3 had malrotation >15 degrees, and none had a leg length inequality >1 cm. Three patients had an unplanned surgery as follows: 2 for prominent implants and 1 for refracture after a second injury. There were no patient, fracture, or treatment characteristics that were predictive of complications or unplanned surgery, including "unstable" fractures (P = 0.78).

CONCLUSION:

Our study demonstrates that flexible elastic nailing can be safely used in most pediatric femoral shaft fractures, including those previously described as "unstable."

LEVEL OF EVIDENCE:

Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

• Authors: Omar Atassi, Philip B Fontenot, Gennadiy Busel, Guadalupe De La Fuente, David Donohue, Benjamin Maxson, Anjan R Shah, David T Watson, Anthony F Infante, Katheryne Downes, Roy W Sanders, Hassan R Mir
• Journal: Journal of orthopaedic trauma (J Orthop Trauma) Vol. 35 Issue 2 Pg. e56-e60 (02 01 2021) ISSN: 1531-2291 [Electronic] United States
• PMID: 33060381 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Topics

• Bone Nails
• Child
• Child, Preschool
• Femoral Fractures (diagnostic imaging, surgery)
• Fracture Fixation, Intramedullary (adverse effects)
• Fracture Healing
• Humans
• Nails
• Retrospective Studies
• Treatment Outcome