Skip to main content

Advertisement

SpringerLink
Log in

Complications of elastic stable intramedullary nailing of femoral shaft fractures in children weighing fifty kilograms (one hundred and ten pounds) and more

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Aim

The purpose of this study was to assess treatment outcomes in children weighing 50 kg (110 pounds) or more with displaced femur shaft fractures treated by elastic stable intramedullary nailing (ESIN) and to identify potential correlations between nail size/medullary canal diameter ratio and outcome.

Methods

Twenty out of 117 consecutive children surgically treated by ESIN for displaced fractures of the femoral shaft with no associated neurovascular injury weighed 50 kg (110 pounds) or more. All patients underwent regular clinical and radiographic follow-up for at least one year after their index surgery.

Results

The average patient age at the time of injury was 13.1 years (25th and 75th interquartile range [IQR] = 11.7–14.5). The mean follow-up was 27.4 months (IQR = 18.4–36.8). Overall, nine (45 %) adverse events were observed. The rate of complications was higher among children weighting 55 kg and over (67 %) than in children weighing less than 55 kg (35 %) and among children aged 13 years old or older (72 %) than among children younger than 13 years old (11 %).

Discussion

Femoral shaft fractures in children and adolescents weighing 50 kg (110 pounds) and over and older than ten years of age have an increased rate of complications.

Conclusion

Heavier patients have a greater chance of complications. In particular, patients younger than 13 years old and weighing less than 55 kg can be safely managed with ESIN, but older and heavier patients should preferably be treated with rigid fixation systems due to a greater complication rate. However, further studies are needed to consolidate the conclusions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ligier JN, Métaizeau JP, Prévot J (1983) Closed flexible medullary nailing in pediatric traumatololgy. Chir Pediatr 24:383–385

    CAS  PubMed  Google Scholar 

  2. Ligier JN, Métaizeau JP, Prévot J, Lascombes P (1988) Elastic stable intramedullary nailing of femoral shaft fractures in children. J Bone Joint Surg (Br) 70:74–77

    CAS  Google Scholar 

  3. Métaizeau JP (1988) Ostéosynthèse chez l’enfant: embrochage centromédullaire élastique, stable. Sauramps Médical, Montpellier

  4. Carey TP, Galpin RD (1996) Flexible intramedullary nail fixation of pediatric femoral fractures. Clin Orthop Relat Res 332:110–118

    Article  Google Scholar 

  5. Bar-On E, Sagiv S, Porat S (1997) External fixation or flexible intramedullary nailing for femoral shaft fractures in children. J Bone Joint Surg (Br) 79:975–978

    Article  CAS  Google Scholar 

  6. Moroz LA, Launay F, Kocher MS, Newton PO, Rick S, Sponseller PD, Flynn JM (2006) Titanium elastic nailing of fractures of the femur in children. Predictors of complications and poor outcome. J Bone Joint Surg (Br) 88:1361–1366. doi:10.1302/0301-620X.88B10.17517

    Article  CAS  Google Scholar 

  7. Narayanan UG, Phillips JH (2012) Flexibility in fixation: an update on femur fractures in children. J Pediatr Orthop 32(Suppl 1):S32–39. doi:10.1097/BPO.0b013e318255b19f

    Article  PubMed  Google Scholar 

  8. Flynn JM, Luedtke LM, Ganley TJ, Dawson J, Davidson RS, Dormans JP, Ecker ML, Gregg JR, Horn BD, Drummond DS (2004) Comparison of titanium elastic nails with traction and a spica cast to treat femoral fractures in children. J Bone Joint Surg Am 86-A:770–777

    Article  PubMed  Google Scholar 

  9. Brousil J, Hunter JB (2013) Femoral fractures in children. Curr Opin Pediatr 25:52–57. doi:10.1097/MOP.0b013e32835c20e0

    Article  PubMed  Google Scholar 

  10. Ramseier LE, Janicki JA, Weir S, Narayanan UG (2010) Femoral fractures in adolescents: a comparison of four methods of fixation. J Bone Joint Surg Am 92:1122–1129. doi:10.2106/JBJS.H.01735

    Article  PubMed  Google Scholar 

  11. Weiss JM, Choi P, Ghatan C, Skaggs DL, Kay RM (2009) Complications with flexible nailing of femur fractures more than double with child obesity and weight >50 kg. J Child Orthop 3:53–58. doi:10.1007/s11832-008-0149-2

    Article  PubMed  Google Scholar 

  12. Leet AI, Pichard CP, Ain MC (2005) Surgical treatment of femoral fractures in obese children: does excessive body weight increase the rate of complications? J Bone Joint Surg Am 87:2609–2613

    PubMed  Google Scholar 

  13. Backstrom IC, MacLennan PA, Sawyer JR, Creek AT, Rue LW, Gilbert SR (2012) J Trauma Acute Care Surg 73:966–971

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ho CA, Skaggs DL, Tang CV, Kay RM (2006) Use of flexible intramedullary nails in pediatric femur fractures. J Pediatr Orthop 26:497–504

    Article  PubMed  Google Scholar 

  15. Lascombes P (2010) Flexible Intramedullary Nailing in Children. The Nancy University Manual, Springer, Berlin

    Book  Google Scholar 

  16. Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J (2001) Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications. J Pediatr Orthop 21:4–8

    Article  CAS  PubMed  Google Scholar 

  17. Lascombes P, Nespola A, Poircuitte JM, Popkov D, de Gheldere A, Haumont T, Journeau P (2012) Early complications with flexible intramedullary nailing in childhood fracture: 100 cases managed with precurved tip and shaft nails. Orthop Traumatol Surg Res 98:369–375. doi:10.1016/j.otsr.2011.11.011

    Article  CAS  PubMed  Google Scholar 

  18. Luhmann SJ, Schootman M, Schoenecker PL, Dobbs MB, Gordon JE (2003) Complications of titanium elastic nails for pediatric femoral shaft fractures. J Pediatr Orthop 23:443–447

    PubMed  Google Scholar 

  19. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R et al (2000) CDC growth charts: United States. Adv Data 314:1–27

    Google Scholar 

  20. Lascombes P, Huber H, Fay R, Popkov D, Haumont T, Journeau P (2013) Flexible intramedullary nailing in children: nail to medullary canal diameters optimal ratio. J Pediatr Orthop 33:403–408. doi:10.1097/BPO.0b013e318285c54d

    Article  PubMed  Google Scholar 

  21. Hunter JB (2005) The principles of elastic stable intramedullary nailing in children. Injury 36(Suppl 1):A20–24

    Article  PubMed  Google Scholar 

  22. Wang Y, Lim H (2012) The global childhood obesity epidemic and the association between socio-economic status and childhood obesity. Int Rev Psychiatry 24:176–188

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Surgery Department, University Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont Ferrand, France

    Federico Canavese, Lorenza Marengo, Mounira Mansour, Marie Rousset & Antoine Samba

  2. Pediatric Orthopaedic Surgery Department, Regina Margherita Children’s Hospital, Piazza Polonia 94, 10126, Torino, Italy

    Antonio Andreacchio & Matteo Paonessa

  3. Faculty of Medicine, University of Montpellier, 2 Rue de l’École de Médecine, 34090, Montpellier, France

    Alain Dimeglio

Authors
  1. Federico Canavese
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lorenza Marengo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Antonio Andreacchio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mounira Mansour
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matteo Paonessa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marie Rousset
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Antoine Samba
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alain Dimeglio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Federico Canavese.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest in the research.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

No patients were involved. This is a retrospective study of patient’s data, and an IRB approval was obtained.

Source of Funding

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Canavese, F., Marengo, L., Andreacchio, A. et al. Complications of elastic stable intramedullary nailing of femoral shaft fractures in children weighing fifty kilograms (one hundred and ten pounds) and more. International Orthopaedics (SICOT) 40, 2627–2634 (2016). https://doi.org/10.1007/s00264-016-3259-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-016-3259-3

Keywords

Search

Navigation