title: Decreased complications of pediatric femur fractures with a change in management.
abstract: BACKGROUND
  Elastic intramedullary nails are commonly the preferred treatment option for operative stabilization of pediatric diaphyseal femur fractures. Increased complication rates have been reported in unstable fractures and older patients treated with TENs (titanium elastic nails). The reported complications have led to a change in management at our institution: limiting the use of TENs and using submuscular plating and trochanteric entry nails as alternatives. The purpose of this study is to analyze whether this change in management has improved outcomes defined by a decrease in complications between 2 time periods.
  
  
  METHODS
  This retrospective study compared 2 cohorts of femur fractures: those treated from January 2001 to January 2003 versus those treated from January 2003 to December 2006. Patient's age, weight, fracture type (stable or unstable), operative fixation technique, and complications were compared. Outcomes were measured by major or minor complications that occurred after operative treatment.
  
  
  RESULTS
  Period I consisted of 46 patients and Period II of 95 patients. There was a significant decrease in TEN use in unstable fractures in Period II versus Period I. Submuscular plating increased from 9% in Period I to 28% in Period II. All complications decreased from 52% in Period I to 23% in Period II. Major complications decreased from 22% to 5%, and minor complications decreased from 30% to 18%. Complications in unstable fractures decreased from 57% to 26% and in stable fractures from 48% to 22%.
  
  
  CONCLUSIONS
  Outcomes of pediatric femur fractures are improved with limiting the use of TENs to stable fractures. Complications resulting from unstable femur fracture management have decreased with other methods of stabilization such as submuscular plating or trochanteric entry nails.
authors.affiliation: Department of Orthopaedic Surgery, The Children's Hospital, The University of Colorado, Denver, Aurora, CO 80045, USA. Sink.Ernest@tchden.org
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Sink
authors.forename: Francis
authors.initials: F
authors.lastname: Faro
authors.forename: John
authors.initials: J
authors.lastname: Polousky
authors.forename: Katherine
authors.initials: K
authors.lastname: Flynn
authors.forename: Jane
authors.initials: J
authors.lastname: Gralla
mesh_terms: D001858:Bone Nails; D001860:Bone Plates; D002648:Child; D015331:Cohort Studies; D005264:Femoral Fractures / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D014025:Titanium