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EXTERNAL FIXATION OR FLEXIBLE INTRAMEDULLARY NAILING FOR FEMORAL SHAFT FRACTURES IN CHILDREN

A PROSPECTIVE, RANDOMISED STUDY

E. Bar-On, MD, Director

Orthopaedic Unit, Schneider Children’s Medical Centre of Israel, 14 Kaplan Street, Petah Tikva 49202, Israel.

S. Sagiv, MD, Deputy Director

Orthopaedic Department, Kaplan Hospital, PO Box 1, Rehovot 76100, Israel.

S. Porat, MD, MCh Orth, Director

Paediatric Orthopaedic Unit, Hadassah University Hospital, PO Box 12000, Jerusalem 91120, Israel.

Correspondence should be sent to Dr E. Bar-On.

We report the outcome of 19 children aged 5.2 to 13.2 years with 20 fractures of the femoral shaft requiring surgery, who were randomly assigned to have external fixation (EF) or flexible intramedullary nailing (FIN) (10 fractures each). The duration of the operation averaged 56 minutes for the EF group with 1.4 minutes of fluoroscopy, compared with 74 minutes and 2.6 minutes, respectively, for the FIN group.

The early postoperative course was similar, but the EF group showed much more callus formation. The time to full weight-bearing, full range of movement and return to school were all shorter in the FIN group. The FIN complications included one transitory foot drop and two cases of bursitis at an insertion site. In the EF group there was one refracture, one rotatory malunion requiring remanipulation and two pin-track infections.

At an average follow-up of 14 months two patients in the EF group had mild pain, four had quadriceps wasting, one had leg-length discrepancy of over 1 cm, four had malalignment of over 5°, and one had limited hip rotation. In the FIN group, one patient had mild pain and one had quadriceps wasting; there were no length discrepancies, malalignment or limitation of movement. Parents of the FIN group were more satisfied.

We recommend the use of flexible intramedullary nailing for fractures of the femoral shaft which require surgery, and reserve external fixation for open or severely comminuted fractures.




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 J Bone Joint Surg BrHome page
L. A. Moroz, F. Launay, M. S. Kocher, P. O. Newton, S. L. Frick, P. D. Sponseller, and J. M. Flynn
Titanium elastic nailing of fractures of the femur in children: PREDICTORS OF COMPLICATIONS AND POOR OUTCOME
J Bone Joint Surg Br, October 1, 2006; 88-B(10): 1361 - 1366.
[Abstract] [Full Text] [PDF]


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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General