title: [Therapy of pediatric femoral fractures. Two versus three elastic stable intramedullary nails].
abstract: BACKGROUND
  The conservative treatment of pediatric femoral fractures can be socially and financially burdensome for patients and families due to the long period of immobilization. New operative techniques have consistently gained significance in the treatment of such fractures due to a shorter period of immobilization. Elastic stable intramedullary nailing (ESIN) in particular has been proven to lead to better outcome in comparison to conservative treatment. This article presents the first study that compares the outcome of three versus two ESINs in the treatment of pediatric femoral shaft fractures.
  
  
  METHODS
  A retrospective analysis of all patients who underwent operative treatment of femoral fractures with ESINs in our hospital from 2009-2012 was carried out. A follow-up examination was performed in mid-2013 by standardized evaluation of leg length discrepancy and the movement capacity of the hip and knee joint.
  
  
  RESULTS
  The follow-up examination revealed a leg length discrepancy of the injured leg when three ESINs were used (p = 0.013) and an impairment of the movement capacity in the hip joint of the injured leg (p = 0.029). In addition the surgery time for metal removal of three ESINs was higher (p = 0.046). All other evaluated parameters did not show any differences.
  
  
  CONCLUSIONS
  In this study population the treatment of pediatric femoral shaft fractures with three ESINs showed no benefit in comparison to two ESINs and therefore should not be used to treat femoral fractures. The leg length discrepancy using three ESINs may be explained by a nonsymmetrical distribution of support points leading to an increased micromovement of the bone with increased callus formation.
authors.affiliation: Klinik für Kinderchirurgie und Kinderurologie, Kinderkrankenhaus, Kliniken der Stadt Köln gGmbH, Amsterdamer Str. 59, 50735, Köln, Deutschland, papers.semaan@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Semaan
authors.forename: T
authors.initials: T
authors.lastname: Klein
authors.forename: T M
authors.initials: TM
authors.lastname: Boemers
authors.forename: M R
authors.initials: MR
authors.lastname: Vahdad
mesh_terms: D001858:Bone Nails; D002675:Child, Preschool; D019544:Equipment Failure Analysis; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D007870:Leg Length Inequality / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome