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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)

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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.

Key words

Femoral fracture - elastic stable intramedullary nail - children - leg length discrepancy

References

  • 1 Aronson D D, Singer R M, Higgins R F. et al . Skeletal traction for fractures of the femoral shaft in children. A long-term study.  J Bone Joint Surg [Am]. 1987;  69 1435-1439
    PubMedSearch in Google Scholar
  • 2 Bar-On E, Sagiv S, Porat S. External fixation or flexible intramedullary nailing for femoral shaft fractures in children. A prospective, randomised study.  J Bone Joint Surg [Br]. 1997;  79 975-978
    PubMedSearch in Google Scholar
  • 3 Berger P, De Graaf J S, Leemans R. The use of elastic intramedullary nailing in the stabilisation of paediatric fractures.  Injury. 2005;  36 1217-1220
    CrossrefPubMedSearch in Google Scholar
  • 4 Blount W P. Fractures in Children. New York; Krieger 1977: 129-170
    Search in Google Scholar
  • 5 Buess E, Kaelin A. One hundred pediatric femoral fractures: epidemiology, treatment attitudes and early complications.  J Pediatr Orthop. 1998;  7 186-192
    PubMedSearch in Google Scholar
  • 6 Flynn J M, Hresko T, Reynolds R AK. et al . Titanium elastic nails for pediatric femur fractures: a multi centre study of early results with analysis of complications.  J Pediatr Orthop. 2001;  21 4-8
    PubMedSearch in Google Scholar
  • 7 Flynn J M, Luedtke L M, Ganley T J. et al . Comparison of titanium elastic nails with traction and a spica cast to treat femoral fractures in children.  J Bone Joint Surg [Am]. 2004;  86 770-777
    PubMedSearch in Google Scholar
  • 8 Gardner M J, Lawrence B D, Griffith M H. Surgical treatment of pediatric femoral shaft fractures.  Curr Opin Pediatr. 2004;  16 51-57
    CrossrefPubMedSearch in Google Scholar
  • 9 Geerdes B P, Heineman E, Spruit P J. 3-week traction with 3-week spica-cast immobilization is as good as 6-week traction and much cheaper.  Ned Tijdschr Geneeskd. 1994;  138 1118-1121
    PubMedSearch in Google Scholar
  • 10 Gross R H, Davidson R, Sullivan J A. et al . Cast brace management of the femoral shaft fracture in children and young adults.  J Pediatr Orthop. 1983;  3 572-582
    PubMedSearch in Google Scholar
  • 11 Heij H A, Ekkelkamp S, Vos A. Hypertension associated with skeletal traction in children.  Eur J Pediatr. 1992;  151 543-545
    CrossrefPubMedSearch in Google Scholar
  • 12 Heinrich S D, Drvaric D M, Darr K. et al . The operative stabilization of pediatric diaphyseal femur fractures with flexible intramedullary nails: a prospective analysis.  J Pediatr Orthop. 1994;  14 501-507
    PubMedSearch in Google Scholar
  • 13 Kissel E U, Miller M E. Closed Ender nailing of femur fracture in older children.  J Trauma. 1989;  29 1585-1588
    PubMedSearch in Google Scholar
  • 14 Ligier J N, Metaizeau J P, Prévot J. et al . Elastic stable intramedullary nailing of femoral shaft fractures in children.  J Bone Joint Surg [Br]. 1988;  70 74-77
    PubMedSearch in Google Scholar
  • 15 Ligier J N, Metaizeau J P, Prévot J, Lascombes P. Elastic stable intramedullary pinning of long bone shaft fractures in children.  Z Kinderchir. 1985;  40 209-212
    PubMedSearch in Google Scholar
  • 16 Linhart W E, Roposch A. Elastic stable intramedullary nailing for unstable femoral fractures in children: preliminary results of a new method.  J Trauma. 1999;  47 372-378
    CrossrefPubMedSearch in Google Scholar
  • 17 Luhmann S J, Schootman M, Schoenecker P L. et al . Complications of titanium elastic nails for pediatric femoral shaft fractures.  J Pediatr Orthop. 2003;  23 443-447
    CrossrefPubMedSearch in Google Scholar
  • 18 Maier M, Maier-Heidkamp P, Lehnert M. et al . Results of femoral shaft fractures in childhood in relation to different treatment modalities.  Unfallchirurg. 2003;  106 48-54
    CrossrefPubMedSearch in Google Scholar
  • 19 Metaizeau J P. Stable elastic intramedullary nailing for fractures of the femur in children.  JBJS [Br]. 2004;  86 954-957
    PubMedSearch in Google Scholar
  • 20 Narayanan U G, Hyman J E, Wainwright A M. et al . Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them.  J Pediatr Orthop. 2004;  24 363-369
    CrossrefPubMedSearch in Google Scholar
  • 21 Newton P O, Mubarak S J. Financial aspects of femoral shaft fracture treatment in children and adolescents.  J Pediatr Orthop. 1994;  14 508-512
    PubMedSearch in Google Scholar
  • 22 Özdemir H M, Yensel U, Senaran. et al . Immediate percutaneous intramedullary fixation and functional bracing for the treatment of pediatric femoral shaft fracture.  J Pediatr Orthop. 2003;  23 453-457
    CrossrefPubMedSearch in Google Scholar
  • 23 Prismant, Information for strategy and policy. www.prismant.nl . 
  • 24 Prokop A, Jubel A, Hahn U. et al . Stabilizing intramedullary pediatric shaft fractures.  Kongressbd Dtsch Ges Chir Kongr. 2002;  119 689-694
    PubMedSearch in Google Scholar
  • 25 Rockwood C A, Wilkins K E. Fractures in Children. Philadelphia; Lippincott 1996: 941-980
    Search in Google Scholar
  • 26 Schnater J M, Sleeboom C, Raaymakers E LFB. et al . Femoral shaft fractures in children younger than 4 years: shorter hospital stay with traction at home.  Ned Tijdschr Geneeskd. 1998;  142 1324-1327
    PubMedSearch in Google Scholar
  • 27 Stans A A, Morrissy R T, Renwick S E. Femoral shaft fracture treatment in patients age 6 to 16 years.  J Pediatr Orthop. 1999;  19 222-228
    CrossrefPubMedSearch in Google Scholar
  • 28 Sugi M, Cole W G. Early plaster treatment for fractures of the femoral shaft in childhood.  J Bone Joint Surg [Br]. 1987;  69 743-746
    PubMedSearch in Google Scholar
  • 29 Wessel L, Seyfriedt C. Leg length inequality following pediatric femoral fractures - final or temporary phenomenon.  Unfallchirurg. 1996;  99 275-282
    PubMedSearch in Google Scholar
  • 30 Wright J G, Wang E EL, Owen J L. et al . Treatments for paediatric femoral fractures: a randomised trial.  The Lancet. 2005;  365 1153-1158
    CrossrefPubMedSearch in Google Scholar
  • 31 Wright J G. The treatment of femoral shaft fractures in children: a systematic overview and critical appraisal of the literature.  Can J Surg. 2000;  43 180-189
    PubMedSearch in Google Scholar
  • 32 Yandow S M, Archibeck M J, Stevens P M. et al . Femoral-shaft fractures in children: a comparison of immediate casting and traction.  J Pediatr Orthop. 1999;  19 55-59
    CrossrefPubMedSearch in Google Scholar

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