title: Surgical treatment of femoral diaphyseal fractures in children using elastic stable intramedullary nailing by open reduction at Yopougon Teaching Hospital.
abstract: BACKGROUND
  Elastic stable intramedullary nailing (ESIN) has transformed children's femoral shaft fracture treatment, but this technique requires an image intensifier. Without it, open reduction is used to check fracture reduction and pin passage. The aim of this study was to describe our techniques and to evaluate our results at the middle term.
  
  
  OBJECTIVE
  The open reduction and ESIN technique provides satisfactory results with few major complications.
  
  
  METHODS
  This was a retrospective study that focused on femoral diaphyseal fractures treated in the pediatric surgery unit at Yopougon Teaching Hospital (Abidjan, Côte d'Ivoire) between January 2007 and December 2013. Twenty children older than 6 years of age who underwent open reduction and ESIN without image intensifier assistance were included. Functional outcomes were assessed using Flynn's criteria. Postoperative complications and sequelae were recorded.
  
  
  RESULTS
  At the 16-month follow-up, the results were excellent in 11 (55%) cases, good in eight (40%), and poor in one (5%) case. The mean duration of surgery was 71min (range, 57-103 min). The mean time for bone healing was 11.6 weeks (range, 7-15 weeks) and the average time to nail removal was 6 months. Complications included wood infection (n=3), skin irritation (n=3), knee stiffness (n=2), malunion (n=3), scar (n=5), and leg length discrepancy (n=3).
  
  
  CONCLUSIONS
  Open reduction and ESIN yielded satisfactory results with few major complications. This method could be an alternative in low-income countries where the image intensifier is often unavailable.
  
  
  METHODS
  Level IV retrospective study.
authors.affiliation: Service de chirurgie pédiatrique, CHU de Yopougon, 21 BP 632 Abidjan 21, Cote d'Ivoire. Electronic address: enanblaodette@yahoo.fr.
authors.forename: J B
authors.initials: JB
authors.lastname: Yaokreh
authors.affiliation: Service de chirurgie pédiatrique, CHU de Yopougon, 21 BP 632 Abidjan 21, Cote d'Ivoire.
authors.forename: T H
authors.initials: TH
authors.lastname: Odéhouri-Koudou
authors.affiliation: Service de chirurgie pédiatrique, CHU de Yopougon, 21 BP 632 Abidjan 21, Cote d'Ivoire.
authors.forename: K M
authors.initials: KM
authors.lastname: Koffi
authors.affiliation: Service de chirurgie pédiatrique, CHU de Yopougon, 21 BP 632 Abidjan 21, Cote d'Ivoire.
authors.forename: M
authors.initials: M
authors.lastname: Sounkere
authors.affiliation: Service de chirurgie pédiatrique, CHU de Yopougon, 21 BP 632 Abidjan 21, Cote d'Ivoire.
authors.forename: Y G S
authors.initials: YG
authors.lastname: Kouamé
authors.affiliation: Service de chirurgie pédiatrique, CHU de Yopougon, 21 BP 632 Abidjan 21, Cote d'Ivoire.
authors.forename: S
authors.initials: S
authors.lastname: Tembely
authors.affiliation: Service de chirurgie pédiatrique, CHU de Yopougon, 21 BP 632 Abidjan 21, Cote d'Ivoire.
authors.forename: D B
authors.initials: DB
authors.lastname: Kouamé
authors.affiliation: Service de chirurgie pédiatrique, CHU de Yopougon, 21 BP 632 Abidjan 21, Cote d'Ivoire.
authors.forename: O
authors.initials: O
authors.lastname: Ouattara
authors.affiliation: Service de chirurgie pédiatrique, CHU de Yopougon, 21 BP 632 Abidjan 21, Cote d'Ivoire.
authors.forename: K R
authors.initials: KR
authors.lastname: Dick
mesh_terms: D002648:Child; D007560:Cote d'Ivoire; D003906:Developing Countries; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: Children; Elastic stable intramedullary nailing; Femoral shaft fractures