Eur J Pediatr Surg 2006; 16(6): 432-437
DOI: 10.1055/s-2006-924737
Original Article

Georg Thieme Verlag KG Stuttgart, New York · Masson Editeur Paris

Long-Term Outcome of Elastic Stable Intramedullary Fixation (ESIF) of Femoral Fractures in Children

B. P. Vierhout1 , Chr. Sleeboom1 , D. C. Aronson1 , A. D. P. Van Walsum2 , G. Zijp3 , H. A. Heij1
  • 1Paediatric Surgical Centre of Amsterdam - VUmc (VU University Medical Centre), Amsterdam and Emma Children's Hospital AMC, Amsterdam, The Netherlands
  • 2Medisch Spectrum Twente, Enschede, The Netherlands
  • 3MCA (Alkmaar Medical Centre), Alkmaar, The Netherlands
Further Information

Publication History

Received: May 1, 2006

Accepted after Revision: May 13, 2006

Publication Date:
08 January 2007 (online)

Abstract

In 1993 a prospective data collection of all femoral fracture in children below 16 years of age was initiated in 4 hospitals in the Netherlands. Follow-up was at least two years, with the aim to evaluate leg length discrepancies (LLD). Over a period of 10 years, we included 136 patients < 16 years of age with femoral fractures. Seventy-one patients who were treated with an ESIF-(Elastic Stable Intramedullary Fixation) nail were studied: 44 boys and 27 girls, between the ages of 3 - 16 years, 23 of which had multiple injuries. Five patients had a Ist or IInd degree open fracture. The average length of stay (LOS) of children with an isolated fracture, was 10 days, and in case of multiple injuries: 12 days. Intra-operative complications were: a broken drill in 2 and an open reduction in 6 cases. Two patients with superficial wound infection were successfully treated with antibiotics. Seven patients had knee complaints of the nails, of which 3 had actually been displaced. Three other patients showed displacement of the nails at X-ray, but had no complaints. At six months follow-up, at the time of removal of the nails, 10 patients had a leg length discrepancy (LLD) exceeding 10 mm. Three children had a clinically significant rotational deformity at this time. Two and a half years after injury 6 patients showed a persistent LLD of more than 10 mm. In all 6 the fractured limb was longer. At ten years of follow-up the LLD persisted in 5 patients. One patient had a persistent clinically significant rotational deformity of more than 10 °. The advantages of ESIF-nails are: reduction of hospital stay and rapid mobilisation. The disadvantages: two operations (for insertion and removal) with a risk of complication. Long-term follow-up, preferably till growth stops, is necessary to conclude whether persistent lengthening of the fractured limb remains a problem.

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M.D., Ph.D. H. A. Heij

VU University Medical Centre

P.O. Box 7057

1007 MB Amsterdam

The Netherlands

Email: ha.heij@vumc.nl