Limb geometry after elastic stable nailing for pediatric femoral fractures.
BACKGROUND
Elastic stable intramedullary nailing has become a popular treatment for pediatric long-bone fractures. However, early limb malalignment and length differences may occur in children with femoral fractures who are managed with this procedure.


METHODS
We prospectively followed sixty-eight children (mean age, 5.6 years) who were managed with elastic stable intramedullary nailing for the treatment of a unilateral femoral shaft fracture in order to evaluate early angular or rotational malalignment or limb-length discrepancy. The average body weight was 21 kg (range, 10 to 45 kg). There were fifty-seven AO/ASIF Type-A fractures and eleven Type-B fractures. Malalignment was assessed with use of radiographs, computed tomography, or navigated ultrasound examination after four to seven months to evaluate the short-term result of fixation and to eliminate changes caused by later bone remodeling.


RESULTS
The mean femoral length difference was 0.5 mm of femoral lengthening. Only eleven patients (16%) had a limb-length discrepancy of >10 mm. Mechanical axial deviation of >5 degrees occurred in one patient. However, the mean femoral rotational angle difference was 14.5 degrees . Thirty-two children (47%) had > or =15 degrees of torsional malalignment.


CONCLUSIONS
Elastic stable intramedullary nailing can provide satisfactory results in terms of limb length and axial alignment, but a high rate of early torsional malalignment may be seen.
Department of Orthopaedic Surgery, Cairo University, 11562 Cairo, Egypt. khaled_hamedsalem@hotmail.com
Khaled Hamed
KH
Salem
Peter
P
Keppler
D001696:Biomechanical Phenomena; D001858:Bone Nails; D002648:Child; D002675:Child, Preschool; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D005269:Femur / Q000000981:diagnostic imaging* / Q000601:surgery; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D017102:Fracture Healing; D006801:Humans; D007223:Infant; D007870:Leg Length Inequality / Q000000981:diagnostic imaging; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography