Outcomes of Treatment of Diaphyseal Femur Fracture Using Titanium Elastic Nail Fixation in Children of Eastern Nepal: A Prospective Study


Authors : Dr. Nabin Khadka; Dr. B.P Shrestha; Dr. R. Rijal; Dr. R. Maharjan; Dr. J. Shah; Dr. J. Bajracharya

Volume/Issue : Volume 10 - 2025, Issue 1 - January


Google Scholar : https://tinyurl.com/5dv9h35t

Scribd : https://tinyurl.com/59nbeemz

DOI : https://doi.org/10.5281/zenodo.14737956


Abstract : Background and Objectives: The management of femoral shaft fractures in pediatric age has always been a subject of discussion. In this study, we are ascertaining the functional outcomes following the use of Titanium Elastic Nails for diaphyseal femoral fractures in children.  Material and Methods: This prospective observational study was performed on 23 patients of age 5 to 15 years with diaphyseal femur fracture who were operated and fixed with intramedullary TENS in the Department of Orthopedics, BP Koirala Institute of Health and Sciences from May 2020 to April 2021. Patients were evaluated to ascertain the functional outcomes of titanium elastic nail fixation in diaphyseal fracture of femur in pediatric age group using Flynn’s scoring criteria.  Result: All 23 patients were evaluated for a period of 6 months. Radiological union in all cases were attained in a mean time of 14.61 weeks. Average duration of hospital stay was 4.3 days. Limb length discrepancy and malalignment were notable in none of the cases. The results were excellent in 21 patients (91.3%), satisfactory in 2 (8.7%) and poor in zero patient(0%) at 6 month period.  Conclusion: Based on these results, TENS is a safe, mini-invasive, reliable, rapid and efficacious method for the management of diaphyseal femur fractures in children.

Keywords : Femur Fracture, Diaphyseal, Pediatric, Outcomes, Titanium Elastic Nail System.

References :

  1. Flynn JM, Skaggs D, Sponseller PD, Ganley TJ, Kay RM, Leitch KK. The operative management of pediatric fractures of the lower extremity. JBJS. 2002 Dec 1;84(12):2288-300.
  2. McCartney D, Hinton A, Heinrich SD. Operative stabilization of pediatric femur fractures. The Orthopedic clinics of North America. 1994 Oct;25(4):635-50.
  3. Loder RT, Feinberg JR. Epidemiology and mechanisms of femur fractures in children. Journal of Pediatric Orthopaedics. 2006 Sep 1;26(5):561-6.
  4. Vishwanath C, Satheesh GS. Surgical outcome of fracture shaft femur in children using flexible intramedullary nailing. International Journal of Orthopaedics. 2017;3(3):1137-51.
  5. Momberger N, Stevens P, Smith J, Santora S, Scott S, Anderson J. Intramedullary nailing of femoral fractures in adolescents. Journal of Pediatric Orthopaedics. 2000 Jul 1;20(4):482-4.
  6. Lee SS, Mahar AT, Newton PO. Ender nail fixation of pediatric femur fractures: a biomechanical analysis. Journal of Pediatric Orthopaedics. 2001 Jul 1;21(4):442-5.
  7. Arora KK, Singh S, Chaudhary P, Kapila R, Sharma R, Singh M. Evaluation of surgical fixation of paediatric diaphyseal long bone fractures in lower limb with elastic stable intramedullary nailing (Esin). International Journal of Orthopaedics. 2017;3(4):501-4.
  8. Hunter JB. The principles of elastic stable intramedullary nailing in children. Injury. 2005 Feb;36:A20.
  9. Ward WT, Rihn JA. The impact of trauma in an urban pediatric orthopaedic practice. JBJS. 2006 Dec 1;88(12):2759-64.
  10. Karn MA, Ragiel CA. The psychologic effects of immobilization on the pediatric orthopaedic patient. Orthopaedic nursing. 1986 Nov 1;5(6):12-6.
  11. Hughes BF, Sponseller PD, Thompson JD. Pediatric femur fractures: effects of spica cast treatment on family and community. Journal of pediatric orthopedics. 1995 Jul 1;15(4):457-60.
  12. Kirby RM, Winquist RA, Hansen Jr ST. Femoral shaft fractures in adolescents: a comparison between traction plus cast treatment and closed intramedullary nailing. Journal of Pediatric Orthopaedics. 1981 Oct 1;1(2):193-8.
  13. Scherl SA, Miller L, Lively N, Russinoff S, Sullivan CM, Tornetta III P. Accidental and nonaccidental femur fractures in children. Clinical Orthopaedics and Related Research (1976-2007). 2000 Jul 1;376:96-105.
  14. Carey TP, Galpin RD. Flexible intramedullary nail fixation of pediatric femoral fractures. Clinical Orthopaedics and Related Research®. 1996 Nov 1;332:110-8.
  15. Aronson J, Tursky EA. External fixation of femur fractures in children. Journal of Pediatric Orthopaedics. 1992 Mar 1;12(2):157-63.
  16. Beaty JH, Austin SM, Warner WC, Canale ST, Nichols L. Interlocking Intramedullary nailing of femoral-shaft  fractures in  adolescents: preliminary results and complications. Journal of pediatric orthopedics. 1994 Mar  1;14(2):178-83.
  17. Kocher MS, Sink EL, Blasier DR, Luhmann SJ, Mehlman CT, Scher DM, Matheney T, Sanders JO, Watters III WC, Goldberg MJ, Keith MW. Treatment of pediatric diaphyseal femur fractures. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2009 Nov 1;17(11):718-25.
  18. Hinton RY, Lincoln A, Crockett MM, Sponseller P, Smith G. Fractures of the femoral shaft in children. Incidence, mechanisms, and sociodemographic risk factors. JBJS. 1999 Apr 1;81(4):500-7.
  19. Egol KA, Koval KJ, Zuckerman JD. Handbook of fractures. Lippincott Williams & Wilkins; 2006.
  20. Schwend RM, Werth C, Johnston A. Femur shaft fractures in toddlers and young children: rarely from child abuse. Journal of Pediatric Orthopaedics. 2000 Jul 1;20(4):475-81.
  21. Hedlund R, Lindgren U. The incidence of femoral shaft fractures in children and adolescents. Journal of Pediatric Orthopaedics. 1986 Jan 1;6(1):47-56.
  22. Bandil D, Bandil MG. Assessment of Results of Treatment of Paediatric  Femoral  Diaphyseal Fractures with Titanium Elastic       Nails.  International Journal of Contemporary Medicine Surgery and Radiology. 2018;3:111-3.
  23. Baig MS, Thutari N, Kodandapani K, Vadlamani KV, Tilak M. Comprehensive study of management of diaphyseal fractures of long bones in children by titanium elastic nailing system. Journal of Evolution of Medical and Dental Sciences. 2019 Apr 1;8(13):969-74.
  24. Bhuyan BK, Singh SM. Titanium elastic nailing in pediatric femoral diaphyseal fractures in the age group of 5–16 years–A short term study. Journal of clinical orthopaedics and trauma. 2014 Dec 1;5(4):203-10.
  25. Garner MR, Bhat SB, Khujanazarov I, Flynn JM, Spiegel D. Fixation of length-stable femoral shaft fractures in heavier children: flexible nails vs rigid locked nails. Journal of Pediatric Orthopaedics. 2011 Jan 1;31(1):11- 6.
  26. Sarkar S, Bandyopadhyay R, Mukherjee A. Titanium Elastic Nail- Complications in the Treatment of Paediatric Diaphyseal Fracture of Femur. The Open Orthopaedics Journal. 2013;7:12.
  27. El-Adl G, Mostafa MF, Khalil MA, Enan A. Titanium elastic nail fixation for paediatric femoral and tibial fractures. Acta Orthopaedica Belgica. 2009 Aug 1;75(4):512.
  28. Saikia K, Bhuyan S, Bhattacharya T, Saikia S: Titanium elastic nailing in femoral diaphyseal fractures of children in 6-16 years of age. Indian J Orthop. 2007 Oct;41(4):381-5
  29. Siddiqui AA, Abousamra O, Compton E, Meisel E, Illingworth KD. Titanium elastic nails are a safe and effective treatment for length unstable pediatric femur fractures. Journal of Pediatric Orthopaedics. 2020 Aug 7;40(7):e560-5.
  30. Memeo A, Panuccio E, D’Amato RD, Colombo M, Boero S, Andreacchio A, Origo C, Pedretti L. Retrospective, multicenter evaluation of complications in the treatment of diaphyseal femur fractures in pediatric patients. Injury. 2019 Feb 7.
  31. Greisberg J, Bliss MJ, Eberson CP, Solga P. Social and economic benefits of flexible intramedullary nails in the treatment of pediatric femoral shaft fractures. Orthopedics. 2002 Oct 1;25(10):1067-70.
  32. Ho CA, Skaggs DL, Tang CW, Kay RM. Use of flexible intramedullary nails in pediatric femur fractures. Journal of Pediatric Orthopaedics. 2006 Jul 1;26(4):497-504.
  33. Bar-on E, Sagiv S. and Porat S. ‘External fixation or flexible intramedullary nailing for femoral shaft fractures in children’. J Bone Joint Surg (Br) 1997; 79-B: 975-8.
  34. Heinrich SD, Drvaric DM, Darr K, MacEwen GD. The operative stabilization of pediatric diaphyseal femur fractures with flexible intramedullary            nails:      a prospective analysis.Journal of Pediatric Orthopaedics. 1994 Jul 1;14(4):501-7.
  35. Salem KH, Keppler P. Limb geometry after elastic stable nailing for pediatric femoral fractures. JBJS. 2010 Jun 1;92(6):1409-17.
  36. Kocher MS, Sink EL, Blasier RD, Luhmann SJ, Mehlman CT, Scher DM, Matheney T, Sanders JO, Watters III WC, Goldberg MJ, Keith MW. American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of pediatric diaphyseal femur fracture. JBJS. 2010 Jul 21;92(8):1790-2.
  37. Rasool MN, Govender S, Naidoo KS. Treatment of femoral shaft fractures in children by early spica casting. South African Medical Journal. 1989;76(8).
  38. Raney EM, Ogden JA, Grogan DP. Premature greater trochanteric epiphysiodesis secondary to intramedullary femoral rodding. Journal of pediatric orthopedics. 1993;13(4):516-20.
  39. Fein LH, Pankovich AM, Spero CM, Baruch HM. Closed flexible intramedullary nailing of adolescent femoral shaft fractures. Journal of orthopaedic trauma. 1989;3(2):133-41.
  40. Jolly A, Patil NV, Bansal R, Pattanshetti V. Comparative study of the outcome of pediatric femur diaphyseal fractures treated with titanium elastic nails vs. compression plates. Int J Res Orthop. 2017 Jan;3(1):80-5.
  41. Olivo CA, Ibargüengoytia JA, Cavazos FV, Salazar JF, Moreno JA. Diaphyseal Femur Fractures in Children: A Preliminary Study Comparing the use of Elastic Stable Intramedullary Nailing (ESIN) Versus Locking Compression Plates (LCP). J Musculoskelet Disord Treat. 2017;3:029.
  42. Reddy R, Reddy S, Uniyal P, Reddy R. Comparative study between titanium elastic nailing (TENS) and dynamic compression plating (DCP) in the treatment of femoral diaphyseal fractures in chidlren.J Evid Based Med. 2015 Jul;2(32)4822-4835.
  43. Ligier JN, Metaizeau JP, Prévot J, Lascombes P. Elastic stable intramedullary nailing of femoral shaft fractures in children. The Journal of Bone and Joint Surgery. British volume. 1988 Jan;70(1):74-7.
  44. Becker T, Weigl D, Mercado E, Katz K, Bar-On E. Fractures and refractures after femoral locking compression plate fixation in children and adolescents. Journal of Pediatric Orthopaedics. 2012 Oct 1;32(7):e40-6.
  45. Caird MS, Mueller KA, Puryear A, Farley FA. Compression plating of pediatric femoral shaft fractures. Journal of Pediatric Orthopaedics. 2003 Jul 1;23(4):448-52.

Background and Objectives: The management of femoral shaft fractures in pediatric age has always been a subject of discussion. In this study, we are ascertaining the functional outcomes following the use of Titanium Elastic Nails for diaphyseal femoral fractures in children.  Material and Methods: This prospective observational study was performed on 23 patients of age 5 to 15 years with diaphyseal femur fracture who were operated and fixed with intramedullary TENS in the Department of Orthopedics, BP Koirala Institute of Health and Sciences from May 2020 to April 2021. Patients were evaluated to ascertain the functional outcomes of titanium elastic nail fixation in diaphyseal fracture of femur in pediatric age group using Flynn’s scoring criteria.  Result: All 23 patients were evaluated for a period of 6 months. Radiological union in all cases were attained in a mean time of 14.61 weeks. Average duration of hospital stay was 4.3 days. Limb length discrepancy and malalignment were notable in none of the cases. The results were excellent in 21 patients (91.3%), satisfactory in 2 (8.7%) and poor in zero patient(0%) at 6 month period.  Conclusion: Based on these results, TENS is a safe, mini-invasive, reliable, rapid and efficacious method for the management of diaphyseal femur fractures in children.

Keywords : Femur Fracture, Diaphyseal, Pediatric, Outcomes, Titanium Elastic Nail System.

Never miss an update from Papermashup

Get notified about the latest tutorials and downloads.

Subscribe by Email

Get alerts directly into your inbox after each post and stay updated.
Subscribe
OR

Subscribe by RSS

Add our RSS to your feedreader to get regular updates from us.
Subscribe