Background: Paediatric femoral fractures are treated by a variety of method. The choice of treatment may be influenced by the age of the child, the level and pattern of the fracture and to a great extent, by regional, institutional or surgeons` preferences. A systematic review of the literature provides little evidence to support one method of treatment over another.
Objectives: The aim of the study was to evaluate the efficacy of Titanium elastic nails( flexible intramedullary) as a fixation device of paediatric femoral shaft fractures.
Methods: This is retrospective interventional study done at the department of Orthopaedics,B.P.Koirala Institute of Health Sciences,Dharan,Nepal over a period of 2 years from March 2007 to April 2009. A total of 45 children with 45 closed fractures were treated by this method. The patient’s age ranged from 6 to 12 years and the mean follow-up was 18 weeks. All patients had open femoral growth plates at the time of surgery.
Results: The study comprised of 45 children with 45 femoral shaft fractures. The age incidence in this series ranged from 6 years to 12 years (an average of 9 years). Thirty children were males and fifteen were females. All the fractures in this series were recent closed fractures. The fracture pattern was transverse or short oblique in fourty cases, Spiral in three cases and comminuted in two cases. 25 fractures occupied the middle third, 9 fractures occupied distal third and 1 fracture upper third of the femur. The mechanism of injury included falls from height (60%), motor vehicle accidents (28%) and sports related injury (12%).
Discussion: Paediatric femoral fractures are treated by a variety of methods including traction, immediate spica cast, traction followed by spica cast, internal fixation with plate and screws, external fixation and intramedullary fixation. The indications for Titanium elastic nail for fixation of paediatric femoral shaft fractures are expanding as their advantages are realized and complications of other operative methods of stabilization are reported. Compression platings are associated with high incidence of refracture. External fixators are associated with pin tract infection, loss of reduction, refracture after removal of external fixator and rigid intramedullary nailing are associated with greater trochanter physis leading to growth arrest with subsequent coxa valga. It is also associated with damage to blood supply of femoral head leading to osteonecrosis of femoral head.These problems and complications are overcome by introduction of flexible intramedullary nailing(TENS) for treatment of paediatric femoral shaft fractures with following advantages. Our results are compatible with results of other series of TENS in terms of union, no implant failur,no refracture after implant removal, within acceptable limb length descrepancies
Conclusion: Titanium elastic nail is an excellent method of managing most, but not all, paediatric femoral fractures that need operative stabilization. It is by no means the only technique nor is there evidence yet that it is superior to other methods. Its advantages make it a valuable choice to consider in managing these fractures.
P Chaudhary, B.P Shrestha, G.P Khanal, R Maharjan.
Department of orthopaedics, B.P.Koirala Institute of Health sciences, Dharan, Nepal