Abstract
The traditional treatment method of pediatric femoral shaft fracture has been traction and spica casting.This method is safe but prolonged immobilization, frequent X-ray , pin tract infections are some of the disadvantages. Internal fixation has become an alternative treatment in especially children between 6-10 years. Surgical treatment has been advocated for children who have multiple injuries or severe head injury. Compression plate fixation provides rigid and stable fixation but requires extensive dissection. Fixation of the fractures with flex-ible intramedullary nailing is another alternative treatment method and is safe and effective especially in simple transverse and short oblique fractures.In the current study we tried to evaluate the results of flexible intramedullary nailing and compare them with compression plate fixation. Thirty four patients with 36 femoral segments were included to the study. Clinical and radiological records of the patients were evaluated retrospectively. Patient’s demographic data, mechanism of injury, type of treatment , duration of the operation ,age ,side were obtained from the files. 19 femoral segments were treated with compression plating .There were 13 male and 5 female patients in this group. The mean age was 7.7 (6-10).The mean operation time was 100 minutes.(75-160 minutes- time between entering and leaving the operation room )Average time to healing was calculated as 7.7 (4-10 ) months.In this group, four femoral segment non-unions and implant failures occured in 6-10 months time .These patients were managed with titanium elastic nail.17 femoral segments were treated with titanium elastic nail ( TEN ).There were 10 male and 6 female patients in this group.The mean age of the patients were 7.9 years ( 7-10 ) .There were four patients managed with plate fixation previously . Revision surgery was done with implant removal and open reduction.The remaining 12 patients were operated with closed reduction and nailing. The mean operation time for this group was 86 ( 45-135) minutes . No immobilization method was used and partial weigth bearing permitted after the surgery.The mean healing time was 4 ( 3-7 ) months for this group. As we compare the both groups , the results were similiar. Average operation time was shorter in the nailing group but there were no statistically significant difference between the two groups. ( p> 0.05) . Average healing time was statistically significantly shorter in the nailing group. ( p= 0.038)
It is generally accepted that plating is a traditionally safe and effective method; this study demonstrates that flexible intramedullary nailing maintains shorter operation time and shorter time to healing . The lack of need of post-operative immobilization , and small incisions for the insertion of the nail which is cosmetically more acceptable are the other advantages of this method.
Conclusion: Internal fixation with flexible intramedul-lary nailing of the femoral fractures in pediatric age group is an advocatable solution.
Local Host: British Society for Children’s Orthopaedic Surgery. Conference Theme: Congenital Deficiencies of the Lower Limb. These abstracts were prepared by A.Catterall.
