Use of elastic nailing for the treatment of paediatric long bone fractures in community hospital settings

  • Charalampos Konstantoulakis
  • Dimitrios Chasiouras
  • Georgios Iliakis
  • Antonios Christou
  • Antonios Kivernitakis
  • Vasilios Petroulakis
Keywords: intramedullary nailing, children, fracture, district hospital

Abstract

Background:  Long bone fractures in the paediatric population are treated with elastic intramedullary nailing. Nailing techniques and hardware have evolved significantly since its initial introduction in the early 1980s and they are considered a reliable method in treating these fractures. In Greece, the surgical management of these fractures is usually performed by specialist surgeons in tertiary paediatric hospitals.

Technique: With this retrospective study we investigate the operative management of paediatric and adolescent long bone fractures treated by general Orthopaedic surgeons in a community hospital. Our aim is to assess whether elastic intramedullary nailing is a reliable and appropriate treatment in community hospital settings.

Patients and methods: We retrospectively reviewed 58 patients with a total of 75 fractures   that have been managed operatively in our hospital from February 2006 until February 2015. There were 6 femoral, 7 tibial, 27 radial shaft, 4 radial head, 23 ulna and 8 humeral fractures. The mean age was 10.6 years (range 4 -17 years) and the male to female ratio 4:1.

Results and Conclusion: All fractures where anatomically reduced, there were four cases of skin irritation at nail insertion and two delayed unions in femoral fractures that resolved without compromise. The range of motion returned to levels equal to the uninjured side. There was one case of leg length discrepancy due to a femoral fracture that was subsequently managed with a distal femoral epiphysiodesis. Our series had no significant deviations from the bibliographic average in terms of functional and aesthetic result, complications and bed stay compared to major health centers in Greece and abroad.

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Author Biographies

Charalampos Konstantoulakis

1Consultant Orthopaedic Surgeon, Chania General Hospital, email: bekonst@yahoo.com

tel:(Study design, performed measurements, manuscript preparation)

 

Dimitrios Chasiouras

Orthopaedic Surgeon,  Royal Derby Hospital, East Midlands, UK, email: dimitrios.chasiouras@doctors.org.uk

Georgios Iliakis

Orthopaedic Surgeon, Chania General Hospital, email: iliakis76@gmail.com 

Antonios Christou

Orthopaedic Surgeon, Birmingham Children’s Hospital, UK, email: christou.ant@gmail.com

Antonios Kivernitakis

Orthopaedic Surgery Trainee, Chania General Hospital, email: kyvernhthsantwn@gmail.com

Vasilios Petroulakis

Consultant Orthopaedic Surgeon, Chania General Hospital, email: basipet@gmail.com

References

1. Lascombes P, Haumont T, Journeau P. Use and abuse of flexible intramedullary nailing in children and adolescents. Journal of pediatric orthopedics. 2006 Nov-Dec;26(6):827-34. Epub 2006/10/27.
2. Mazda K, Khairouni A, Pennecot GF, Bensahel H. Closed flexible intramedullary nailing of the femoral shaft fractures in children. Journal of pediatric orthopedics Part B. 1997 Jul;6(3):198-202. Epub 1997/07/01.
3. Barry M, Paterson JM. A flexible intramedullary nails for fractures in children. The Journal of bone and joint surgery British volume. 2004 Sep;86(7):947-53. Epub 2004/09/28.
4. Vrsansky P, Bourdelat D, Al Faour A. Flexible stable intramedullary pinning technique in the treatment of pediatric fractures. Journal of pediatric orthopedics. 2000 Jan-Feb;20(1):23-7. Epub 2000/01/21.
5. Huber RI, Keller HW, Huber PM, Rehm KE. Flexible intramedullary nailing as fracture treatment in children. Journal of pediatric orthopedics. 1996 Sep-Oct;16(5):602-5. Epub 1996/09/01.
6. Jubel A, Andermahr J, Isenberg J, Issavand A, Prokop A, Rehm KE. Outcomes and complications of elastic stable intramedullary nailing for forearm fractures in children. Journal of pediatric orthopedics Part B. 2005 Sep;14(5):375-80. Epub 2005/08/12.
7. Swindells MG, Rajan RA. Elastic intramedullary nailing in unstable fractures of the paediatric tibial diaphysis: a systematic review. Journal of children’s orthopaedics. 2010 Feb;4(1):45-51. Epub 2009/12/04.
8. Rajan RA, Hawkins KJ, Metcalfe J, Konstantoulakis C, Jones S, Fernandes J. Elastic stable intramedullary nailing for displaced proximal humeral fractures in older children. Journal of children’s orthopaedics. 2008 Feb;2(1):15-9. Epub 2009/03/25.
9. Garg NK, Ballal MS, Malek IA, Webster RA, Bruce CE. Use of elastic stable intramedullary nailing for treating unstable forearm fractures in children. The Journal of trauma. 2008 Jul;65(1):109-15. Epub 2008/06/27.
10. Schmittenbecher PP. State-of-the-art treatment of forearm shaft fractures. Injury. 2005 Feb;36 Suppl 1:A25-34. Epub 2005/01/18.
11. Blasier RD, Aronson J, Tursky EA. External fixation of pediatric femur fractures. Journal of pediatric orthopedics. 1997 May-Jun;17(3):342-6. Epub 1997/05/01.
12. Ligier JN, Metaizeau JP, Prevot J, Lascombes P. Elastic stable intramedullary nailing of femoral shaft fractures in children. The Journal of bone and joint surgery British volume. 1988 Jan;70(1):74-7. Epub 1988/01/01.
13. Raney EM, Ogden JA, Grogan DP. Premature greater trochanteric epiphysiodesis secondary to intramedullary femoral rodding. Journal of pediatric orthopedics. 1993 Jul-Aug;13(4):516-20. Epub 1993/07/01.
14. Langkamer VG, Ackroyd CE. Removal of forearm plates. A review of the complications. The Journal of bone and joint surgery British volume. 1990 Jul;72(4):601-4. Epub 1990/07/01.
15. Greisberg J, Bliss MJ, Eberson CP, Solga P, d’Amato C. Social and economic benefits of flexible intramedullary nails in the treatment of pediatric femoral shaft fractures. Orthopedics. 2002 Oct;25(10):1067-70; discussion 70. Epub 2002/10/29.
16. Hughes BF, Sponseller PD, Thompson JD. Pediatric femur fractures: effects of spica cast treatment on family and community. Journal of pediatric orthopedics. 1995 Jul-Aug;15(4):457-60. Epub 1995/07/01.
17. Schmittenbecher PP, Dietz HG, Uhl S. [Late results of forearm fractures in childhood]. Der Unfallchirurg. 1991 Apr;94(4):186-90. Epub 1991/04/01.
18. Flynn JM, Luedtke L, Ganley TJ, Pill SG. Titanium elastic nails for pediatric femur fractures: lessons from the learning curve. American journal of orthopedics (Belle Mead, NJ). 2002 Feb;31(2):71-4. Epub 2002/03/06.
19. Lascombes P, Huber H, Fay R, Popkov D, Haumont T, Journeau P. Flexible intramedullary nailing in children: nail to medullary canal diameters optimal ratio. Journal of pediatric orthopedics. 2013 Jun;33(4):403-8. Epub 2013/05/09.
20. Lascombes P, Prevot J, Ligier JN, Metaizeau JP, Poncelet T. Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases. Journal of pediatric orthopedics. 1990 Mar-Apr;10(2):167-71. Epub 1990/03/01.
21. Narayanan UG, Hyman JE, Wainwright AM, Rang M, Alman BA. Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them. Journal of pediatric orthopedics. 2004 Jul-Aug;24(4):363-9. Epub 2004/06/19.
22. Schmittenbecher Peter P. DHG, Linhart Wolfgang E., Slongo Theddy Complications and Problems in Intramedullary Nailing of Children’s Fractures European Journal of Trauma 2000.
23. Luhmann SJ, Schootman M, Schoenecker PL, Dobbs MB, Gordon JE. Complications of titanium elastic nails for pediatric femoral shaft fractures. Journal of pediatric orthopedics. 2003 Jul-Aug;23(4):443-7. Epub 2003/06/27.
24. Flynn JM, Skaggs DL, Sponseller PD, Ganley TJ, Kay RM, Leitch KK. The surgical management of pediatric fractures of the lower extremity. Instructional course lectures. 2003;52:647-59. Epub 2003/04/15.
25. Metaizeau JP. Stable elastic intramedullary nailing for fractures of the femur in children. The Journal of bone and joint surgery British volume. 2004 Sep;86(7):954-7. Epub 2004/09/28.
26. Anastasopoulos J, Petratos D, Konstantoulakis C, Plakogiannis C, Matsinos G. Flexible intramedullary nailing in paediatric femoral shaft fractures. Injury. 2010 Jun;41(6):578-82. Epub 2009/11/13.
27. Anastasopoulos J, Petratos D, Balas E, Morakis E, Matsinos G. Elastic intramedullary nailing for the treatment of forearm fractures in children. Orthopaedic Proceedings. 2011;93-B(SUPP_III):358-.
28. Flynn JM, Jones KJ, Garner MR, Goebel J. Eleven years experience in the operative management of pediatric forearm fractures. Journal of pediatric orthopedics. 2010 Jun;30(4):313-9. Epub 2010/05/27.
Published
2020-03-24