Closed reduction and titanium elastic nailing in diaphyseal femoral and tibial fractures in children

Year 2022, Volume: 47 Issue: 2, 563 - 569, 30.06.2022

Ahmet Küçük , Zeynel Mert Asfuroğlu , Nusret Köse

https://doi.org/10.17826/cumj.1030769

Abstract

Purpose: The aim of this study was to evaluate clinical and radiological results of children who were treated using titanium elastic nail (TEN) for femoral and tibial diaphyseal fractures.
Materials and Methods: A total of 49 (15 female, 34 male) femur shaft fractures (FF group) and 35 (12 female, 23 male) tibial shaft fractures (TF group) were retrospectively analyzed. Time until the operation (in days), duration of hospital stays (in days), time to union (in weeks), and the time to implant removal (in months) were recorded. In the final follow up; limb length discrepancy (mm), angulation, restrictions in the range of hip and knee joint motion were measured. Flynn Score was used for clinical results.
Results: The mean age was 7.96 in the FF group and 9.34 in the TF group. The mean follow-up time was 51.3 months in the FF Group and 58.3 months in the TF group. The mean duration of hospital stay was 1.4 days in both groups. The mean time for bony union was 9.7 weeks and 10.7 weeks for the FF and the TF groups, respectively. The mean time to implant removal was 7.1 months and 6.22 months for the FF and the TF groups, respectively. Flynn scores were poor in 3 patients, successful in 6 patients and excellent in 40 patients in the FF group; whereas it was poor in 1 patient, successful in 2 patients and excellent in 32 patients in the TF group. None of the patients had major complications. Bony union was achieved in all patients.
Conclusion: Intramedullary fixation using TEN is a successful treatment method with satisfactory clinical results and low complication rates for pediatric femoral and tibial diaphyseal fractures.

Keywords

pediatric fractures, titanium elastic nailing, closed reduction

Çocuk femur ve tibia şaft kırıklarında kapalı redüksiyon ve titanyum elastik çivileme

Abstract

Amaç: Bu çalışmada femur ve tibia diyafiz kırıklarında titanyum elastik çivileme (TEÇ) ile tedavi edilen çocuk hastaların klinik ve radyolojik sonuçlarının değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: TEÇ uygulanan 49 (15 kız, 34 erkek) femur diyafiz kırığı (FK grubu) ve 35 (12 kız, 23 erkek) tibia diyafiz kırığı (TK grubu) geriye dönük olarak incelendi. Ameliyata kadar geçen süre (gün), hastanede kalış süresi (gün), kemik kaynama süresi (ay) ve implant çıkarma süresi (ay) kayıt altına alındı. Son kontrolde, bacak uzunluk farkı (mm), açılanma, kalça ve diz eklemi hareket açıklıkları ölçüldü. Klinik skorlama için Flynn skorlaması kullanıldı.
Bulgular: Yaş ortalaması FK grubunda 7,96, TK grubunda ise 9,34 yıl idi. Ortalama takip süresi FK grubunda 51,3 ay, TK grubunda ise 58,3 ay idi. Ortalama hastanede yatış süresi her iki grup için 1,4 gün olarak bulundu. Ortalama kırık kaynama süreleri FK ve TK grubunda sırasıyla 9,7 hafta ve 10,7 haftaydı. Ortalama implant çıkarma süreleri ise FK ve TK grubunda sırasıyla 7,1 ay ve 6,22 ay idi. Flynn skorları FK grubunda 3 hastada kötü, 6 hastada başarılı ve 40 hastada mükemmel; TK grubunda ise 1 hastada kötü, 2 hastada başarılı ve 32 hastada mükemmel olarak hesaplandı. Tüm hastalarda kemik kaynaması sağlandı.
Sonuç: Titanyum elastik çivi ile kanal içi sabitleme yüksek tatmin edici klinik sonuçları ve düşük komplikasyon oranı ile birlikte çocuk femur ve tibia şaft kırıklarında başarılı bir tedavi yöntemidir.

Keywords

çocuk kırıkları, titanyum elastik çivileme, kapalı redüksiyon

References

• 1. Slongo TF, Audige L, Group AOPC. Fracture and dislocation classification compendium for children: the AO pediatric comprehensive classification of long bone fractures (PCCF). J Orthop Trauma. 2007;21:135-60.
• 2. Ligier JN, Metaizeau JP, Prevot J, Lascombes P. Elastic stable intramedullary nailing of femoral shaft fractures in children. J Bone Joint Surg Br. 1988;70(1):74-7.
• 3. Rush LV. Dynamic factors in medullary pinning of fractures. Am Surg. 1951;17(9):803-8.
• 4. Chen YN, Lee PY, Chang CW, Ho YH, Peng YT, Chang CH, et al. Biomechanical investigation of titanium elastic nail prebending for treating diaphyseal long bone fractures. Australas Phys Eng Sci Med. 2017;40(1):115-26.
• 5. Sankar WN, Jones KJ, David Horn B, Wells L. Titanium elastic nails for pediatric tibial shaft fractures. J Child Orthop. 2007;1(5):281-6.
• 6. Khoriati AA, Jones C, Gelfer Y, Trompeter A. The management of paediatric diaphyseal femoral fractures: a modern approach. Strategies Trauma Limb Reconstr. 2016;11(2):87-97.
• 7. Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J. Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications. J Pediatr Orthop. 2001;21(1):4-8.
• 8. Hedstrom EM, Svensson O, Bergstrom U, Michno P. Epidemiology of fractures in children and adolescents. Acta Orthop. 2010;81(1):148-53.
• 9. Nisar A, Bhosale A, Madan SS, Flowers MJ, Fernandes JA, Jones S. Complications of Elastic Stable Intramedullary Nailing for treating paediatric long bone fractures. J Orthop. 2013;10(1):17-24.
• 10. Lascombes P, Haumont T, Journeau P. Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop. 2006;26(6):827-34.
• 11. Donati F, Mazzitelli G, Lillo M, Menghi A, Conti C, Valassina A, et al. Titanium elastic nailing in diaphyseal femoral fractures of children below six years of age. World J Orthop. 2017;8(2):156-62. 12. Bhuyan BK, Mohan Singh S. Titanium elastic nailing in pediatric femoral diaphyseal fractures in the age group of 5-16 years - A short term study. J Clin Orthop Trauma. 2014;5(4):203-10.
• 13. Rajak MK, Thakur R, Choudhary A, Bhaduri I, Kumar S. Titanium elastic nailing in femoral diaphyseal fractures in children of 6-14 years age. Acta Orthop Belg. 2016;82(4):883-8. 14. Setter KJ, Palomino KE. Pediatric tibia fractures: current concepts. Curr Opin Pediatr. 2006;18(1):30-5.
• 15. Mashru RP, Herman MJ, Pizzutillo PD. Tibial shaft fractures in children and adolescents. J Am Acad Orthop Surg. 2005;13(5):345-52.
• 16. 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(4):363-9.
• 17. Gicquel P, Giacomelli MC, Basic B, Karger C, Clavert JM. Problems of operative and non-operative treatment and healing in tibial fractures. Injury. 2005;36 Suppl 1:A44-50.
• 18. Heo J, Oh CW, Park KH, Kim JW, Kim HJ, Lee JC, et al. Elastic nailing of tibia shaft fractures in young children up to 10 years of age. Injury. 2016;47(4):832-6. 19. Saseendar S, Menon J, Patro DK. Treatment of femoral fractures in children: is titanium elastic nailing an improvement over hip spica casting? J Child Orthop. 2010;4(3):245-51.
• 20. O'Brien T, Weisman DS, Ronchetti P, Piller CP, Maloney M. Flexible titanium nailing for the treatment of the unstable pediatric tibial fracture. J Pediatr Orthop. 2004;24(6):601-9.
• 21. Kc KM, Acharya P, Sigdel A. Titanium Elastic Nailing System (TENS) for Tibia Fractures in Children: Functional Outcomes and Complications. JNMA J Nepal Med Assoc. 2016;55(204):55-60. 22. Nisar A, Bhosale A, Madan SS, Flowers MJ, Fernandes JA, Jones S. Complications of elastic stable intramedullary nailing for treatind paediatric long bone fractures. J Orthop. 2013;10(1):17-24.
• 23. Guo YC, Feng GM, Xing GW, Yin JN, Xia B, Dong YZ, et al. A meta-analysis of flexible intramedullary nailing versus external fixation for pediatric femoral shaft fractures. J Pediatr Orthop B. 2016;25(5):466-70.