INTRODUCTION: Femoral shaft fractures account for 1.6% of all PAEDIATRIC
INJURIES. In children 5 years or younger, early closed reduction and
application of spica cast is an ideal treatment for most diaphyseal fracture.
In skeletally mature adolescents, use of antegrade solid intramedullary rod
has become standard treatment. But, the best treatment for children
between five to sixteen years of age is still debated. Compared with
younger children, patients in this intermediate age group have high risk of
shortening and malunion when conservative measures used.
Children managed with traction and spica cast as a treatment
modality has to undergo various adverse physical, social, psychological
and financial consequences, of prolonged immobilization. Various other
modalities include external fixation, plates and screws, use of solid
antegrade intramedullary nail are available. However, the risk of certain
complications, particularly pintract infection and refractures after external
fixation or osteonecrosis with solid nails.
In the past seven years fixation with flexible intramedullary nails
have become popular technique, for stabilizing femoral fracture in school
aged children.
ESIN fixation system is a simple, effective and minimally invasive
technique. It gives stable fixation with rapid healing and prompt return of
child to normal activity.
This study was intended to assess the results following treatment of
fracture shaft of femur by flexible intra medullary nail or elastic stable
intramedullary technique.
AIM: The purpose of this study is to analyze the efficacy of ELASTIC
STABLE INTRAMEDULLARY NAILING (TENS) in the treatment of
fracture shaft of femur in children aged between 5 to 16 years with special
emphasis on technical difficulties and complications
MATERIALS AND METHODS: In this study 20 patients aged 5-16 years, with fracture shaft of femur were treated with flexible intramedullary nail with TITANIUM
ELASTIC NAILS (TENS) at Government Rajaji Hospital attached to
Madurai Medical College, Madurai from May 2006 to November 2007.
Inclusion Criteria: • Children and adolescent patients from 5 to 16 year with
diaphyseal femur fracture.
Exclusion Criteria:
• Patients less than 5 years of age and more than 16 years of age.
• Patients unfit for surgery
• Comminuted and segmental fractures.
• Fracture involving the distal 1/3rd of femoral shaft.
RESULTS: All patients were followed until fracture union occurred. The
followup period ranged from 6 months to 18 months. Results were
analysed both clinically and radiologically.
The results were evaluated according to the TENS SCORING
SYSTEM used by FLYNN et al. Majority of the patients i.e. 8 (40%) were in the age group of 5-8 years. The younger patient was 5 years and the oldest was 15 years and the mean age of study was 10.15 years. Majority of patients were males and 2 were females. Major Cause of fractures in our series is RTA.
Right femur involved in 55% of cases. Middle 1/3rd of the shaft was involved in 12 (60%). Associated Injuries: Head Injury -2, Abdominal Injury -1, Ipsilateral Tibia -1, Pelvic fracture -1. Average Time interval between trauma and surgery was 3.95 days. One patient who had a head injury problem, we operated after 2
wks needed an open reduction. Another patient who had compound
required open reduction. We done postoperative immobilization in two cases in form of skin traction in a Thomas Splint, both were comminuted fractures.
2 patient who had superficial infection stayed more than 12 days in
hospital. Average duration of hospital stay in our series in 10.1 days.
CONCLUSION: Twenty patients with 20 diaphyseal fractures were treated with
Elastic Stable Intramedullary nailing between May 2006 to November
2007 at Government Rajaji Hospital, Madurai. Children and adolescents aged between 5 to 16 years were included in this study with the average age being 10.15 years and 90% of them
were boys. RTA is the major course for the fractures and 2 fractures were open
fractures. 12 cases were in middle 1/3 fractures and 8 of them were upper
third and middle third junction fractures.
All patients were operated on a fracture table. 18 fractures were
closely reduced and fixed, 2 cases open reduction done.
Except one case we allowed active hip and knee range of motion
exercise on 2nd post operative day we allowed partial weight bearing
around 3-4 wks and full weight bearing only after clinical and radiological
complete union was evident . Based on our experience and results, we conclude that
ELASTIC STABLE INTRAMEDULLARY NAILING technique
is an ideal method for treatment of pediatric femoral shaft
fractures. It gives elastic mobility promoting rapid union at
fractures site and stability which is ideal for early mobilization.
It gives lower complication rate, good outcome when compared
with other methods of treatment
