0
Scientific Articles   |    
Limb Geometry After Elastic Stable Nailing for Pediatric Femoral Fractures
Khaled Hamed Salem, MD1; Peter Keppler, MD2
1 Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Kasr El-Aini Street, 11562 Cairo, Egypt. E-mail address: khaled_hamedsalem@hotmail.com
2 Department of Trauma, Hand, Plastic and Reconstructive Surgery, Ulm University, Steinhövelstraße 9, 89075 Ulm, Germany
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Department of Trauma, Hand, Plastic and Reconstructive Surgery, Ulm University, Ulm, Germany

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Jun 01;92(6):1409-1417. doi: 10.2106/JBJS.I.00538
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: 

Elastic stable intramedullary nailing has become a popular treatment for pediatric long-bone fractures. However, early limb malalignment and length differences may occur in children with femoral fractures who are managed with this procedure.

Methods: 

We prospectively followed sixty-eight children (mean age, 5.6 years) who were managed with elastic stable intramedullary nailing for the treatment of a unilateral femoral shaft fracture in order to evaluate early angular or rotational malalignment or limb-length discrepancy. The average body weight was 21 kg (range, 10 to 45 kg). There were fifty-seven AO/ASIF Type-A fractures and eleven Type-B fractures. Malalignment was assessed with use of radiographs, computed tomography, or navigated ultrasound examination after four to seven months to evaluate the short-term result of fixation and to eliminate changes caused by later bone remodeling.

Results: 

The mean femoral length difference was 0.5 mm of femoral lengthening. Only eleven patients (16%) had a limb-length discrepancy of >10 mm. Mechanical axial deviation of >5° occurred in one patient. However, the mean femoral rotational angle difference was 14.5°. Thirty-two children (47%) had =15° of torsional malalignment.

Conclusions: 

Elastic stable intramedullary nailing can provide satisfactory results in terms of limb length and axial alignment, but a high rate of early torsional malalignment may be seen.

Level of Evidence: 

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

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Guidelines
    Treatment of pediatric diaphyseal femur fractures. -American Academy of Orthopaedic Surgeons (AAOS)
    Results provided by:
    PubMed
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    12/04/2013
    New York - Icahn School of Medicine at Mount Sinai
    02/28/2014
    District of Columbia (DC) - Children's National Medical Center
    04/02/2014
    W. Virginia - Charleston Area Medical Center
    12/31/2013
    S. Carolina - Department of Orthopaedic Surgery Medical Univerity of South Carlonina