Flexible Interlocked Nailing of Pediatric Femoral Fractures: Experience With a New Flexible Interlocking Intramedullary Nail Compared With Other Fixation Procedures
BACKGROUND:The optimal treatment of femoral shaft fractures in older children and adolescents remains controversial. We hypothesized that fixation with a flexible interlocking intramedullary nail (FIIN) reduces perioperative complications and improves outcomes, including leg-length discrepancy, time...
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| Veröffentlicht in: | Journal of pediatric orthopaedics 2008-12, Vol.28 (8), p.864-873 |
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| creator | Jencikova-Celerin, Lubica Phillips, Jonathan H Werk, Lloyd N Wiltrout, Stacey Armatti Nathanson, Ian |
| description | BACKGROUND:The optimal treatment of femoral shaft fractures in older children and adolescents remains controversial. We hypothesized that fixation with a flexible interlocking intramedullary nail (FIIN) reduces perioperative complications and improves outcomes, including leg-length discrepancy, time to healing, and time to weight bearing compared with other fixation procedures (OFPs) including standard elastic nail implants.
METHODS:Using a retrospective cohort study design, we reviewed medical records and radiographs of children, 7 to 18 years of age, with femoral shaft fractures requiring open treatment between July 1, 1998, and June 30, 2003. Patients selected for the study had unilateral fracture sites proximal to the supracondylar region and distal to the lesser trochanter, presence of open femoral growth plates, and open surgical treatment. Analyses compared inpatient measures and patient outcomes between FIIN and OFP groups.
RESULTS:Of the 160 patients eligible for inclusion, 23 were lost to follow-up. The remaining 137 patients had a mean follow-up of 396.3 days (SD, 320.4 days), with 58 receiving FIIN fixation and 79 OFP. Although the difference was not statistically significant, complications occurred in 19.0% of patients in the FIIN group and 30.4% in the OFP group. Trochanteric heterotopic ossification was the most common complication (13.8%) noted in the FIIN group and superficial infection (12.8%) in the OFP group. The FIIN group experienced less blood loss (P = 0.042) and shorter time to weight bearing (P = 0.001) without disturbance of proximal femoral geometry or avascular necrosis of the femoral head. In children weighing less than 45.5 kg (100 lb), complications were less common with FIIN (3.6%) compared with OFP (24.4%). A subgroup of patients less than 45.5 kg (100 lb) with standard elastic nail implants (n = 24) had 8.1 times the complications of patients with FIIN.
CONCLUSIONS:Older children and adolescents with femoral shaft fractures treated with a FIIN showed improved outcomes compared with patients treated with OFP.
LEVEL OF EVIDENCE:Level III, therapeutic study. |
| doi_str_mv | 10.1097/BPO.0b013e31818e64a1 |
| format | Article |
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METHODS:Using a retrospective cohort study design, we reviewed medical records and radiographs of children, 7 to 18 years of age, with femoral shaft fractures requiring open treatment between July 1, 1998, and June 30, 2003. Patients selected for the study had unilateral fracture sites proximal to the supracondylar region and distal to the lesser trochanter, presence of open femoral growth plates, and open surgical treatment. Analyses compared inpatient measures and patient outcomes between FIIN and OFP groups.
RESULTS:Of the 160 patients eligible for inclusion, 23 were lost to follow-up. The remaining 137 patients had a mean follow-up of 396.3 days (SD, 320.4 days), with 58 receiving FIIN fixation and 79 OFP. Although the difference was not statistically significant, complications occurred in 19.0% of patients in the FIIN group and 30.4% in the OFP group. Trochanteric heterotopic ossification was the most common complication (13.8%) noted in the FIIN group and superficial infection (12.8%) in the OFP group. The FIIN group experienced less blood loss (P = 0.042) and shorter time to weight bearing (P = 0.001) without disturbance of proximal femoral geometry or avascular necrosis of the femoral head. In children weighing less than 45.5 kg (100 lb), complications were less common with FIIN (3.6%) compared with OFP (24.4%). A subgroup of patients less than 45.5 kg (100 lb) with standard elastic nail implants (n = 24) had 8.1 times the complications of patients with FIIN.
CONCLUSIONS:Older children and adolescents with femoral shaft fractures treated with a FIIN showed improved outcomes compared with patients treated with OFP.
LEVEL OF EVIDENCE:Level III, therapeutic study.</description><identifier>ISSN: 0271-6798</identifier><identifier>EISSN: 1539-2570</identifier><identifier>DOI: 10.1097/BPO.0b013e31818e64a1</identifier><identifier>PMID: 19034180</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins, Inc</publisher><subject>Adolescent ; Age Factors ; Bone Nails ; Child ; Cohort Studies ; Equipment Design ; Female ; Femoral Fractures - diagnostic imaging ; Femoral Fractures - surgery ; Follow-Up Studies ; Fracture Fixation, Intramedullary - adverse effects ; Fracture Fixation, Intramedullary - instrumentation ; Fracture Fixation, Intramedullary - methods ; Humans ; Leg Length Inequality ; Male ; Postoperative Complications - etiology ; Radiography ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Weight-Bearing</subject><ispartof>Journal of pediatric orthopaedics, 2008-12, Vol.28 (8), p.864-873</ispartof><rights>2008 Lippincott Williams & Wilkins, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2995-4cd92804587b13affa4c7f99f78ceb899c1ad7b039911cf1338253839936763d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19034180$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jencikova-Celerin, Lubica</creatorcontrib><creatorcontrib>Phillips, Jonathan H</creatorcontrib><creatorcontrib>Werk, Lloyd N</creatorcontrib><creatorcontrib>Wiltrout, Stacey Armatti</creatorcontrib><creatorcontrib>Nathanson, Ian</creatorcontrib><title>Flexible Interlocked Nailing of Pediatric Femoral Fractures: Experience With a New Flexible Interlocking Intramedullary Nail Compared With Other Fixation Procedures</title><title>Journal of pediatric orthopaedics</title><addtitle>J Pediatr Orthop</addtitle><description>BACKGROUND:The optimal treatment of femoral shaft fractures in older children and adolescents remains controversial. We hypothesized that fixation with a flexible interlocking intramedullary nail (FIIN) reduces perioperative complications and improves outcomes, including leg-length discrepancy, time to healing, and time to weight bearing compared with other fixation procedures (OFPs) including standard elastic nail implants.
METHODS:Using a retrospective cohort study design, we reviewed medical records and radiographs of children, 7 to 18 years of age, with femoral shaft fractures requiring open treatment between July 1, 1998, and June 30, 2003. Patients selected for the study had unilateral fracture sites proximal to the supracondylar region and distal to the lesser trochanter, presence of open femoral growth plates, and open surgical treatment. Analyses compared inpatient measures and patient outcomes between FIIN and OFP groups.
RESULTS:Of the 160 patients eligible for inclusion, 23 were lost to follow-up. The remaining 137 patients had a mean follow-up of 396.3 days (SD, 320.4 days), with 58 receiving FIIN fixation and 79 OFP. Although the difference was not statistically significant, complications occurred in 19.0% of patients in the FIIN group and 30.4% in the OFP group. Trochanteric heterotopic ossification was the most common complication (13.8%) noted in the FIIN group and superficial infection (12.8%) in the OFP group. The FIIN group experienced less blood loss (P = 0.042) and shorter time to weight bearing (P = 0.001) without disturbance of proximal femoral geometry or avascular necrosis of the femoral head. In children weighing less than 45.5 kg (100 lb), complications were less common with FIIN (3.6%) compared with OFP (24.4%). A subgroup of patients less than 45.5 kg (100 lb) with standard elastic nail implants (n = 24) had 8.1 times the complications of patients with FIIN.
CONCLUSIONS:Older children and adolescents with femoral shaft fractures treated with a FIIN showed improved outcomes compared with patients treated with OFP.
LEVEL OF EVIDENCE:Level III, therapeutic study.</description><subject>Adolescent</subject><subject>Age Factors</subject><subject>Bone Nails</subject><subject>Child</subject><subject>Cohort Studies</subject><subject>Equipment Design</subject><subject>Female</subject><subject>Femoral Fractures - diagnostic imaging</subject><subject>Femoral Fractures - surgery</subject><subject>Follow-Up Studies</subject><subject>Fracture Fixation, Intramedullary - adverse effects</subject><subject>Fracture Fixation, Intramedullary - instrumentation</subject><subject>Fracture Fixation, Intramedullary - methods</subject><subject>Humans</subject><subject>Leg Length Inequality</subject><subject>Male</subject><subject>Postoperative Complications - etiology</subject><subject>Radiography</subject><subject>Retrospective Studies</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Weight-Bearing</subject><issn>0271-6798</issn><issn>1539-2570</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNplUc1u1DAQthCILoU3QMgnbimeOIltbrBqoFLV3QOIo-U4E9bUiRc70W7fhwfFbVeqBIfxaKTvZzwfIW-BXQBT4sPn7eaCdQw4cpAgsakMPCMrqLkqylqw52TFSgFFI5Q8I69S-sUYCF7xl-QMFOMVSLYif1qPR9d5pFfTjNEHe4s9vTHOu-knDQPdYu_MHJ2lLY4hGk_baOy8REwf6eVxj9HhZJH-cPOOGnqDB_q_5L1WHqIZsV-8N_HuwYKuw7g3MRs-sDfzDiNt3dHMLkx0G4PN8Gz0mrwYjE_45tTPyff28tv6a3G9-XK1_nRd2FKpuqhsr0rJqlqKDrgZBlNZMSg1CGmxk0pZML3oGFcKwA7AuSxrLvPIG9Hwnp-T94-6-xh-L5hmPbpkMS88YViSbpTkIFSTgdUj0MaQUsRB76Mb87c0MH2fjs7p6H_TybR3J_2ly5d4Ip3ieNI9BJ9Pl279csCod2j8vNMMygq4kkXJmIT8sCJXDvwv_RKeBw</recordid><startdate>200812</startdate><enddate>200812</enddate><creator>Jencikova-Celerin, Lubica</creator><creator>Phillips, Jonathan H</creator><creator>Werk, Lloyd N</creator><creator>Wiltrout, Stacey Armatti</creator><creator>Nathanson, Ian</creator><general>Lippincott Williams & Wilkins, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200812</creationdate><title>Flexible Interlocked Nailing of Pediatric Femoral Fractures: Experience With a New Flexible Interlocking Intramedullary Nail Compared With Other Fixation Procedures</title><author>Jencikova-Celerin, Lubica ; Phillips, Jonathan H ; Werk, Lloyd N ; Wiltrout, Stacey Armatti ; Nathanson, Ian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2995-4cd92804587b13affa4c7f99f78ceb899c1ad7b039911cf1338253839936763d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adolescent</topic><topic>Age Factors</topic><topic>Bone Nails</topic><topic>Child</topic><topic>Cohort Studies</topic><topic>Equipment Design</topic><topic>Female</topic><topic>Femoral Fractures - diagnostic imaging</topic><topic>Femoral Fractures - surgery</topic><topic>Follow-Up Studies</topic><topic>Fracture Fixation, Intramedullary - adverse effects</topic><topic>Fracture Fixation, Intramedullary - instrumentation</topic><topic>Fracture Fixation, Intramedullary - methods</topic><topic>Humans</topic><topic>Leg Length Inequality</topic><topic>Male</topic><topic>Postoperative Complications - etiology</topic><topic>Radiography</topic><topic>Retrospective Studies</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Weight-Bearing</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jencikova-Celerin, Lubica</creatorcontrib><creatorcontrib>Phillips, Jonathan H</creatorcontrib><creatorcontrib>Werk, Lloyd N</creatorcontrib><creatorcontrib>Wiltrout, Stacey Armatti</creatorcontrib><creatorcontrib>Nathanson, Ian</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric orthopaedics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jencikova-Celerin, Lubica</au><au>Phillips, Jonathan H</au><au>Werk, Lloyd N</au><au>Wiltrout, Stacey Armatti</au><au>Nathanson, Ian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Flexible Interlocked Nailing of Pediatric Femoral Fractures: Experience With a New Flexible Interlocking Intramedullary Nail Compared With Other Fixation Procedures</atitle><jtitle>Journal of pediatric orthopaedics</jtitle><addtitle>J Pediatr Orthop</addtitle><date>2008-12</date><risdate>2008</risdate><volume>28</volume><issue>8</issue><spage>864</spage><epage>873</epage><pages>864-873</pages><issn>0271-6798</issn><eissn>1539-2570</eissn><abstract>BACKGROUND:The optimal treatment of femoral shaft fractures in older children and adolescents remains controversial. We hypothesized that fixation with a flexible interlocking intramedullary nail (FIIN) reduces perioperative complications and improves outcomes, including leg-length discrepancy, time to healing, and time to weight bearing compared with other fixation procedures (OFPs) including standard elastic nail implants.
METHODS:Using a retrospective cohort study design, we reviewed medical records and radiographs of children, 7 to 18 years of age, with femoral shaft fractures requiring open treatment between July 1, 1998, and June 30, 2003. Patients selected for the study had unilateral fracture sites proximal to the supracondylar region and distal to the lesser trochanter, presence of open femoral growth plates, and open surgical treatment. Analyses compared inpatient measures and patient outcomes between FIIN and OFP groups.
RESULTS:Of the 160 patients eligible for inclusion, 23 were lost to follow-up. The remaining 137 patients had a mean follow-up of 396.3 days (SD, 320.4 days), with 58 receiving FIIN fixation and 79 OFP. Although the difference was not statistically significant, complications occurred in 19.0% of patients in the FIIN group and 30.4% in the OFP group. Trochanteric heterotopic ossification was the most common complication (13.8%) noted in the FIIN group and superficial infection (12.8%) in the OFP group. The FIIN group experienced less blood loss (P = 0.042) and shorter time to weight bearing (P = 0.001) without disturbance of proximal femoral geometry or avascular necrosis of the femoral head. In children weighing less than 45.5 kg (100 lb), complications were less common with FIIN (3.6%) compared with OFP (24.4%). A subgroup of patients less than 45.5 kg (100 lb) with standard elastic nail implants (n = 24) had 8.1 times the complications of patients with FIIN.
CONCLUSIONS:Older children and adolescents with femoral shaft fractures treated with a FIIN showed improved outcomes compared with patients treated with OFP.
LEVEL OF EVIDENCE:Level III, therapeutic study.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>19034180</pmid><doi>10.1097/BPO.0b013e31818e64a1</doi><tpages>10</tpages></addata></record> |
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| ispartof | Journal of pediatric orthopaedics, 2008-12, Vol.28 (8), p.864-873 |
| issn | 0271-6798 1539-2570 |
| language | eng |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adolescent Age Factors Bone Nails Child Cohort Studies Equipment Design Female Femoral Fractures - diagnostic imaging Femoral Fractures - surgery Follow-Up Studies Fracture Fixation, Intramedullary - adverse effects Fracture Fixation, Intramedullary - instrumentation Fracture Fixation, Intramedullary - methods Humans Leg Length Inequality Male Postoperative Complications - etiology Radiography Retrospective Studies Time Factors Treatment Outcome Weight-Bearing |
| title | Flexible Interlocked Nailing of Pediatric Femoral Fractures: Experience With a New Flexible Interlocking Intramedullary Nail Compared With Other Fixation Procedures |
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