Fixation of length-stable femoral shaft fractures in heavier children: Flexible nails vs rigid locked nails

Matthew Garner, Suneel B. Bhat, Ilkhom Khujanazarov, John M. Flynn, David Spiegel

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: The treatment of femoral shaft fractures in heavier children has been studied extensively, however, no study has directly compared elastic nail (TEN) and rigid locking nails (RLN) in this population. Our goal was to compare TEN with RLN in length-stable diaphyseal femur fractures in heavier children and adolescents (47 to 85 kg) using weight-matched cohorts. Methods: We retrospectively reviewed records for length-stable diaphyseal femoral fractures treated with TEN or RLN over 8 years at our Level 1 Pediatric Trauma Center. Perioperative and follow-up data, including total charges for care, were recorded and radiographic images were reviewed. These data were used to create 2 cohorts having each patient in the TEN cohort matched to within 2 kg of the corresponding patient in the RLN cohort. Results: Fifteen patients from each cohort could be weight matched (TEN, 60.8 kg vs. RLN, 60.4 kg). The RNL cohort was older (15.4 vs. 13.5 y; P=0.005). Time in operating room and estimated blood loss were greater in the RLN cohort: 158 versus 220 minutes (P=0.003) and 42 versus 182 ml (P=0.003), respectively. All patients had a full range of motion at the latest follow-up. Complications were observed in 6 of 15 TEN and 10 of 15 RNL (P=0.14). Implant-related problems were more common in RLN patients, but this was not statistically significant (3 of 15 vs. 9 of 15; P=0.06). In the TEN cohort, malunion and leg length discrepancy (>2 cm) each occurred in a single patient (20 degrees varus, 2.3 cm shortening, respectively) compared with 0 of 15 in RLN (P=0.48). Treatment with TEN resulted in a total charge of $742 more than RLN (P=0.75). Conclusions: In our weight-matched comparison, the use of TEN resulted in decreased time in operating room, estimated blood loss, and implant-related problems. Malunion and leg length discrepancy remain of concern when heavier patients are treated by TEN, but were not significantly increased relative to RNL in this study.

Original languageEnglish (US)
Pages (from-to)11-16
Number of pages6
JournalJournal of Pediatric Orthopaedics
Volume31
Issue number1
DOIs
StatePublished - Jan 1 2011

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Femoral Fractures
Nails
Operating Rooms
Weights and Measures
Leg
Trauma Centers
Articular Range of Motion
Femur
Pediatrics

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Garner, Matthew ; Bhat, Suneel B. ; Khujanazarov, Ilkhom ; Flynn, John M. ; Spiegel, David. / Fixation of length-stable femoral shaft fractures in heavier children : Flexible nails vs rigid locked nails. In: Journal of Pediatric Orthopaedics. 2011 ; Vol. 31, No. 1. pp. 11-16.
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abstract = "Background: The treatment of femoral shaft fractures in heavier children has been studied extensively, however, no study has directly compared elastic nail (TEN) and rigid locking nails (RLN) in this population. Our goal was to compare TEN with RLN in length-stable diaphyseal femur fractures in heavier children and adolescents (47 to 85 kg) using weight-matched cohorts. Methods: We retrospectively reviewed records for length-stable diaphyseal femoral fractures treated with TEN or RLN over 8 years at our Level 1 Pediatric Trauma Center. Perioperative and follow-up data, including total charges for care, were recorded and radiographic images were reviewed. These data were used to create 2 cohorts having each patient in the TEN cohort matched to within 2 kg of the corresponding patient in the RLN cohort. Results: Fifteen patients from each cohort could be weight matched (TEN, 60.8 kg vs. RLN, 60.4 kg). The RNL cohort was older (15.4 vs. 13.5 y; P=0.005). Time in operating room and estimated blood loss were greater in the RLN cohort: 158 versus 220 minutes (P=0.003) and 42 versus 182 ml (P=0.003), respectively. All patients had a full range of motion at the latest follow-up. Complications were observed in 6 of 15 TEN and 10 of 15 RNL (P=0.14). Implant-related problems were more common in RLN patients, but this was not statistically significant (3 of 15 vs. 9 of 15; P=0.06). In the TEN cohort, malunion and leg length discrepancy (>2 cm) each occurred in a single patient (20 degrees varus, 2.3 cm shortening, respectively) compared with 0 of 15 in RLN (P=0.48). Treatment with TEN resulted in a total charge of $742 more than RLN (P=0.75). Conclusions: In our weight-matched comparison, the use of TEN resulted in decreased time in operating room, estimated blood loss, and implant-related problems. Malunion and leg length discrepancy remain of concern when heavier patients are treated by TEN, but were not significantly increased relative to RNL in this study.",
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Fixation of length-stable femoral shaft fractures in heavier children : Flexible nails vs rigid locked nails. / Garner, Matthew; Bhat, Suneel B.; Khujanazarov, Ilkhom; Flynn, John M.; Spiegel, David.

In: Journal of Pediatric Orthopaedics, Vol. 31, No. 1, 01.01.2011, p. 11-16.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Fixation of length-stable femoral shaft fractures in heavier children

T2 - Flexible nails vs rigid locked nails

AU - Garner, Matthew

AU - Bhat, Suneel B.

AU - Khujanazarov, Ilkhom

AU - Flynn, John M.

AU - Spiegel, David

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N2 - Background: The treatment of femoral shaft fractures in heavier children has been studied extensively, however, no study has directly compared elastic nail (TEN) and rigid locking nails (RLN) in this population. Our goal was to compare TEN with RLN in length-stable diaphyseal femur fractures in heavier children and adolescents (47 to 85 kg) using weight-matched cohorts. Methods: We retrospectively reviewed records for length-stable diaphyseal femoral fractures treated with TEN or RLN over 8 years at our Level 1 Pediatric Trauma Center. Perioperative and follow-up data, including total charges for care, were recorded and radiographic images were reviewed. These data were used to create 2 cohorts having each patient in the TEN cohort matched to within 2 kg of the corresponding patient in the RLN cohort. Results: Fifteen patients from each cohort could be weight matched (TEN, 60.8 kg vs. RLN, 60.4 kg). The RNL cohort was older (15.4 vs. 13.5 y; P=0.005). Time in operating room and estimated blood loss were greater in the RLN cohort: 158 versus 220 minutes (P=0.003) and 42 versus 182 ml (P=0.003), respectively. All patients had a full range of motion at the latest follow-up. Complications were observed in 6 of 15 TEN and 10 of 15 RNL (P=0.14). Implant-related problems were more common in RLN patients, but this was not statistically significant (3 of 15 vs. 9 of 15; P=0.06). In the TEN cohort, malunion and leg length discrepancy (>2 cm) each occurred in a single patient (20 degrees varus, 2.3 cm shortening, respectively) compared with 0 of 15 in RLN (P=0.48). Treatment with TEN resulted in a total charge of $742 more than RLN (P=0.75). Conclusions: In our weight-matched comparison, the use of TEN resulted in decreased time in operating room, estimated blood loss, and implant-related problems. Malunion and leg length discrepancy remain of concern when heavier patients are treated by TEN, but were not significantly increased relative to RNL in this study.

AB - Background: The treatment of femoral shaft fractures in heavier children has been studied extensively, however, no study has directly compared elastic nail (TEN) and rigid locking nails (RLN) in this population. Our goal was to compare TEN with RLN in length-stable diaphyseal femur fractures in heavier children and adolescents (47 to 85 kg) using weight-matched cohorts. Methods: We retrospectively reviewed records for length-stable diaphyseal femoral fractures treated with TEN or RLN over 8 years at our Level 1 Pediatric Trauma Center. Perioperative and follow-up data, including total charges for care, were recorded and radiographic images were reviewed. These data were used to create 2 cohorts having each patient in the TEN cohort matched to within 2 kg of the corresponding patient in the RLN cohort. Results: Fifteen patients from each cohort could be weight matched (TEN, 60.8 kg vs. RLN, 60.4 kg). The RNL cohort was older (15.4 vs. 13.5 y; P=0.005). Time in operating room and estimated blood loss were greater in the RLN cohort: 158 versus 220 minutes (P=0.003) and 42 versus 182 ml (P=0.003), respectively. All patients had a full range of motion at the latest follow-up. Complications were observed in 6 of 15 TEN and 10 of 15 RNL (P=0.14). Implant-related problems were more common in RLN patients, but this was not statistically significant (3 of 15 vs. 9 of 15; P=0.06). In the TEN cohort, malunion and leg length discrepancy (>2 cm) each occurred in a single patient (20 degrees varus, 2.3 cm shortening, respectively) compared with 0 of 15 in RLN (P=0.48). Treatment with TEN resulted in a total charge of $742 more than RLN (P=0.75). Conclusions: In our weight-matched comparison, the use of TEN resulted in decreased time in operating room, estimated blood loss, and implant-related problems. Malunion and leg length discrepancy remain of concern when heavier patients are treated by TEN, but were not significantly increased relative to RNL in this study.

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