Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2017; 8(2): 156-162
Published online Feb 18, 2017. doi: 10.5312/wjo.v8.i2.156
Titanium elastic nailing in diaphyseal femoral fractures of children below six years of age
Fabrizio Donati, Giuseppe Mazzitelli, Marco Lillo, Amerigo Menghi, Carla Conti, Antonio Valassina, Emanuele Marzetti, Giulio Maccauro
Fabrizio Donati, Giuseppe Mazzitelli, Marco Lillo, Amerigo Menghi, Carla Conti, Antonio Valassina, Emanuele Marzetti, Giulio Maccauro, Orthopedic and Traumatology Institute, Catholic University of the Sacred Heart, 00168 Rome, Italy
Author contributions: All the authors contributed equally to this work; Donati F, Mazzitelli G, Marzetti E and Maccauro G designed the research; Donati F, Lillo M, Menghi A, Conti C and Valassina A performed the research; Donati F, Conti C, Marzetti E and Maccauro G analyzed the data; Donati F, Mazzitelli G, Lillo M and Marzetti E wrote the paper.
Institutional review board statement: The study was reviewed and approved by the Internal ethics committee of orthopedics and traumatology department of Policlinico Gemelli Hospital.
Informed consent statement: All involved persons (subjects or legally authorized representative) gave their informed consent (written or verbal) prior to study inclusion.
Conflict-of-interest statement: No conflict of interest to be declared.
Data sharing statement: Technical appendix, statistical code, and dataset available the first author at fabriziodonati2@hotmail.it.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Emanuele Marzetti, MD, PhD, Orthopedic and Traumatology Institute, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168 Rome, Italy. emarzetti@live.com
Telephone: +39-06-30155559 Fax: +39-06-3051911
Received: July 21, 2016
Peer-review started: July 26, 2016
First decision: September 6, 2016
Revised: October 18, 2016
Accepted: November 21, 2016
Article in press: November 23, 2016
Published online: February 18, 2017
Abstract
AIM

To report the clinical and radiographic results of titanium elastic nail (TEN) in diaphyseal femoral fractures of children below age of six years.

METHODS

A retrospective analysis of 27 diaphyseal femoral fractures in children younger than six years treated with TEN between 2005 and 2015 was conducted. Patients were immobilized in a cast for 5 wk and the nails were removed from 6 to 12 wk after surgery. Twenty-four cases were clinically and radiographically re-evaluated using the Flynn’s scoring criteria, focusing on: Limb length discrepancy, rotational deformity, angulation, hip and knee range of motion (ROM), functional status, complications, and parent’s satisfaction.

RESULTS

Sixteen males and eight females with a mean age of 3.2 years at the time of treatment were re-evaluated at an average follow-up of 58.9 mo. No cases of delayed union were observed. The mean limb lengthening was 0.3 cm. Four cases experienced limb lengthening greater than 1 cm and always minor than 2 cm. Twelve point five percent of the cases showed an angulation < 10°. Complete functional recovery (hip and knee ROM, ability to run and jump on the operated limb) occurred in 95.7% of cases. Complications included two cases of superficial infection of the TEN entry point, one case of refracture following a new trauma, and one TEN mobilization. According to the Flynn’s scoring criteria, excellent results were obtained in 79.2% of patients and satisfactory results in the remaining 20.8%, with an average parent’s satisfaction level of 9.1/10.

CONCLUSION

TEN is as a safe, mini-invasive and surgeon-friendly technique and, considering specific inclusion criteria, it represents a useful and efficacy option for the treatment of diaphyseal femoral fractures even in patients younger than six years of age.

Keywords: Titanium elastic nailing, Pediatric femoral fractures, Elastic stable intramedullary nailing, Surgical treatment, Femural shaft

Core tip: A retrospective analysis of 27 diaphyseal femoral fractures in children younger than six years treated with titanium elastic nailing (TEN) was conducted. Clinical and radiographic evaluations performed using Flynn’s scoring criteria at an average follow-up of 58.9 mo showed 79.2% of excellent results and 20.8% satisfactory results, without delayed union or major complications. Considering the good clinical and radiographic results at mid-term follow-up, TEN showed to be a safe, mini-invasive and surgeon-friendly technique even in patients younger than six years of age.