Titanium elastic nailing in pediatric femoral diaphyseal fractures in the age group of 5-16 years - A short term study.

BACKGROUND: Management of femoral diaphyseal fracture in the age group of 5-16 years is controversial. The purpose of this study is to demonstrate the effectiveness of intramedullary fixation of femoral shaft fractures by using titanium elastic nailing system (TENS).

MATERIALS AND METHODS: Between April 2011 and April 2014, 40 pediatric patients (31 boys, 9 girls) aged 5-16 years with diaphyseal femoral fractures were treated by retrograde TENS fixation. Fractures were classified according to system of Winquest and Hansen as Grade-I (n = 18), Grade-II (n = 10), Grade-III (n = 7) and compound fractures according to the Gustilo and Anderson's classification Grade-I (n = 3), Grade-II (n = 2). The final results were evaluated by using Flynn's criteria.

RESULTS: The mean duration of follow-up was 21 months (range 3-39 months). All fractures were radiologically united with grade 3 callus formation at 8-10 weeks period (mean 9 weeks) and full weight bearing was possible in a mean time of 9.5 weeks. According to Flynn's criteria, excellent result was found in 33 patients (82.5%) and satisfactory in 7 patients (17.5%). Limb lengthening was noticed in 6 cases, varus mal-alignment was in 4 cases and rotational mal-alignment was seen in 3 cases. Peri-operative difficulties encountered were failure of closed reduction in 4 cases and cork screwing of nails in 2 cases.

CONCLUSION: TENS is a safe and effective method for the treatment of pediatric femoral shaft fractures, because it is minimally invasive, relatively easy to use and shows very good functional and cosmetic results.