Treatment of femoral shaft fractures in young children by Ender’s nail: indications & complications

Authors

  • Sunil Nikose Department of Orthopedics, Datta Meghe Institute of Medical Sciences, Sawnagi, Wardha, Maharashtra
  • Mridul Arora Department of Orthopedics, Datta Meghe Institute of Medical Sciences, Sawnagi, Wardha, Maharashtra
  • Pradeep K Singh Department of Orthopedics, Datta Meghe Institute of Medical Sciences, Sawnagi, Wardha, Maharashtra
  • Sandeep Shrivastava Department of Orthopedics, Datta Meghe Institute of Medical Sciences, Sawnagi, Wardha, Maharashtra
  • Shounak Taywade Department of Orthopedics, Datta Meghe Institute of Medical Sciences, Sawnagi, Wardha, Maharashtra

DOI:

https://doi.org/10.18203/2320-6012.ijrms20150800

Keywords:

Ender’s nailing, Femoral diaphyseal fractures, Stable femoral fractures, Unstable femoral fractures

Abstract

Background: Treatment of femoral fractures in age group of 6 – 12 years is controversial. Operative treatment is becoming better accepted. Various modalities of fixation include plate osteosynthesis, External fixation; Antegrade locked nailing, and flexible intramedullary nailing.

Methods: 60 children aged 6-12 years (Average age – 8.2 years) with 66 femoral diaphyseal fractures (61 closed and 05 open) in 60 patients were managed with closed Ender’s nailing. Pathological fractures due to unicameral bone cyst were evident in 5 patients. Femoral shaft fractures at the level proximal to distal three fifth with canal diameter of ≥ 6mm were included in the study. Out of 66 traumatic fractures 42 fractures had stable pattern and 19 had unstable fracture pattern. The results were evaluated clinically and radiologically.

Results: All the 42 stable femoral fractures showed bridging callus in a mean time of 3.83 weeks (2.5 to 6.5 weeks). Full weight bearing was possible in a mean time of 4.19 weeks. Radiological union was seen in a mean time of 9.4 weeks. 34 fractures were evaluated by scanogram one year after injury and they revealed lengthening of 0.3cms. All the children returned to their previous level of activities. All the 19 unstable femoral fractures showed bridging callus in a mean time of 5.53 weeks (4 – 8 weeks). Full weight bearing was possible in a mean time of 6.21weeks. Radiological union was seen in a mean time of 12 weeks. 8 patients were readmitted for adjunctive procedures like nail impaction, traction and cast immobilization. 20% patients with unstable group had shortening of 1.3cms and 20% had external rotation of lower limb.

Conclusions: Ender’s nailing is simple, cost-effective and minimally invasive procedure in 6-12 years of age. It offers stable fixation with rapid healing. There is prompt return of child to normal activity.

 

References

Flynn JM, Skaggs DL, Sponseller PD, Ganley TJ, Kay RM, Kellie Leitch KK. The operative management of pediatric fractures of the lower extremity. J Bone Joint Surg Am. 2002;84:2288–300.

Heybel1y M, Muratli HH, Çeleb L, Gülçek S, Biçimoglu A. The results of intramedullary fixation with titanium elastic nails in children with femoral fractures. Acta Orthop Traumatol Turc.2004;38:178–87.

Narayanan UG, Hyman JE, Wainwright AM, Rang M, Alman BA. Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures and How to avoid them. J Pediatr Orthop. 2004;24:363–9.

Metaizeau JP. Stable elastic nailing for fractures of the femur in children. J Bone Joint Surg Br. 2004;86:954–7.

Reeves RB, Ballard RI, Hughes JL, Jackson Internal fixation versus traction and casting of adolescent femoral shaft fractures. J Pediatr Orthop. 1990;10:592–5.

Ward WT, Levy J, Kaye A. Compression plating for child and adolescent femur fractures. J Paediatr Orthop. 1992;12:626–32.

Aronson J, Torsky EA. External fixation of femur fractures in children. J Pediatr Orthop. 1992;12:157–63.

Krettek C, Haas N, Walker J, Tscherne H. Treatment of femoral shaft fractures in children by external fixation. Injury.1991;22:263–6.

Beaty JH, Austin SM, Warner WC, Canale ST, Nichols L. Interlocking intramedullary nailing of femoral-shaft fractures in adolescents: Preliminary results and complications. J Pediatr Orthop. 1994;14:178–83.

Letts M, Jarvis J, Lawton L, Davidson D. Complications of rigid intramedullary rodding of femoral shaft fractures in children. J Trauma. 2002;52:504–16.

Buford D, Christensen K, Weather P. Intramedullary nailing of femoral fractures in adolescents. Clin Orthop Relat Res.1998;350:85–9.

Bartl V, Melichar I, Gál P. Personal experience with elastic stable intramedullary osteosynthesis in children. Rozhl Chir. 1996 Oct;75(10):486-8.

Ligier JN, Metaizeau JP, Prevot J, Lascombes P. Elastic stable intramedullary nailing of femoral shaft fractures in children. J Bone Joint Surg [Br] l988;70-B:74-7.

Shekhar L, Mayanger J C. A clinical study of Ender nails fixation in femoral shaft fractures in children. Indian J Orthop 2006;40:35-7.

15. Bar-On E, Sagiv S, Porat S. External fixation or flexible intramedullary nailing for femoral shaft fractures in children. A prospective, randomised study. J Bone Joint Surg Br. 1997; 9(6):975-8.

Salem KH, Keppler P. Limb geometry after elastic stable nailing for paediatric femoral fractures. J Bone Joint Surg Am. 2010;92(6):1409-17.

Anastasopoulos J, Petratos D, Konstantoulakis C, Plakogiannis C, Matsinos G. Flexible intramedullary nailing in paediatric femoral shaft fractures. Injury. 2010 Jun;41(6):578-82

Houshian S, Gothgen CB, Pedersen NW. Femoral shaft fractures in children: elastic stable intramedullary nailing in 31 cases. Acta Orthop Scand. 2004;5(3):249-51.

Ozdemir HM, Yensel U, Senaran H. Immediate percutaneous intramedullary fixation and functional bracing for the treatment of pediatric femoral shaft fracture. J Pediatr Orthop. 2003;23(4):453-7.

Downloads

Published

2017-01-14

How to Cite

Nikose, S., Arora, M., Singh, P. K., Shrivastava, S., & Taywade, S. (2017). Treatment of femoral shaft fractures in young children by Ender’s nail: indications & complications. International Journal of Research in Medical Sciences, 3(10), 2613–2617. https://doi.org/10.18203/2320-6012.ijrms20150800

Issue

Section

Original Research Articles