TENS for the surgical management of femoral shaft fractures in 6-14 years age group children

Abstract

Background. Fracture shaft of femur in pediatric age group is one of the most common leading emergencies. Children in the age group of 6-14 years are treated with either traction, hip spica, flexible/elastic stable retrograde intramedullary nail, or external fixators. We conducted a clinical prospective study on the use of Titanium Elastic Nailing System (TENS) for the treatment of femoral shaft fractures in children.

Methods. The prospective study included 45 cases of fresh femoral shaft fractures. The Inclusion Criteria were a) Age group of 6-14 years, b) Recent fracture of femur shaft c) Transverse, short oblique, minimally comminuted fractures.

Results. The clinical results were evaluated using Flynn’s criteria of scoring as, Excellent in 40 patients (88.89 %), Satisfactory in 5 patients (11.12 %) and poor in none. Radiological criteria for fracture union were assessed by using Anthony et al scale. Nine patients developed bursitis at entry point of the nail. Three patients had superficial infection due to bursitis. Full weight bearing was possible in mean time of 8.7 weeks (range; 7-12 weeks).

Conclusion. TENS is very effective in management of paediatric shaft femur fractures in the age group of 6-14 years with advantages of early union, early mobilization and manageable complications.

Keywords

Paediatric fractures / Femur / TENS / Flynn’s criteria

References

[1] 1.Loder RT, O’Donnel PW, Finberg JR. Epidemiology and mechanism of femur fracture in children. J Pediatr Orthop. 2006;26(5):561-566. doi: 10.1097/01.bpo.0000230335.19029.ab.

[2] 2.Beaty JH. Operative treatment of femoral shaft fractures in children and adolescents. Clin Orthop Relat Res. 2005;434:114-22. doi: 10.1097/01.blo.0000163463.05141.1c.

[3] 3.Buckley SL. Current trends in the treatment of femoral shaft fractures in children and adolescents. Clin Orthop Relat Res. 1997;338:60-73. doi: 10.1097/00003086-199705000-00009.

[4] 4.Gwyn DT, Olney BW, Dart BR, Czuwala PJ. Rotational control of various pediatric femur fractures stabilized with Titanium Elastic Nails. J Pediatr Orthop. 2004;24:172-7. doi: 10.1097/00004694-200403000-00007.

[5] 5.Canale ST. Fracture and dislocation in children. In: Canale ST, Beaty JH, et al. Campbell’s Operative Orthopaedics. 11th ed. Philadelphia: Mosby; 2007: 1651-1661.

[6] 6.Lee YH, Lim KB, Gao GX, et al. Traction and spica casting for closed femoral shaft fractures in children. J Orthop Surg (Hong Kong). 2007;15(1):37-40. doi: 10.1177/230949900701500109.

[7] 7.Flynn JM, Skaggs DL, Sponseller PD, et al. The operative management of pediatric fractures of the lower extremity. J Bone Joint Surg Am. 2002;84(12):2288-300. doi: 10.2106/00004623-200212000-00025.

[8] 8.Narayanan UG, Hyman JE, Wainwright AM, et al. Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures and How to avoid them. J Pediatr Orthop. 2004;24(4):363-9. doi: 10.1097/01241398-200407000-00004.

[9] 9.Bhaskar A. Treatment of long bone fractures in children by flexible titanium nails. Indian J Orthop. 2005;39(3):166-8. doi:10.4103/0019-5413.36715.

[10] 10.Flynn JM, Skaggs DL, Sponseller PD, et al. The surgical management of pediatric fractures of the lower extremity. Instr Course Lect. 2003;52:647-59.

[11] 11.Flynn JM, Hresko T, Reynolds RA, et al. Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications. J Pediatr Orthop. 2001;21(1):4-8. doi: 10.1097/01241398-200101000-00003.

[12] 12.Stans AA, Morrisy RT, Renwick SE. Femoral shaft fracture treatment in patients age 6 to 16 years. J Pediatr Orthop. 1999;19(2):222-228. doi: 10.1097/00004694-199903000-00017.

[13] 13.Reeves RB, Ballard RI, Hughes JL, Jackson. Internal fixation versus traction and casting of adolescent femoral shaft fractures. J Pediatr Orthop. 1990;10(5):592-5. doi: 10.1097/01241398-199009000-00004.

[14] 14.Ward WT, Levy J, Kaye A. Compression plating for child and adolescent femur fractures. J Paediatr Orthop. 1992;12(5):626-32. doi: 10.1097/01241398-199212050-00012.

[15] 15.Beaty JH, Austin SM, Warner WC, et al. Interlocking intramedullary nailing of femoral-shaft fractures in adolescents: Preliminary results and complications. J Pediatr Orthop. 1994;14(2):178-83. doi: 10.1097/01241398-199403000-00009.

[16] 16.Letts M, Jarvis J, Lawton L, Davidson D. Complications of rigid intramedullary rodding of femoral shaft fractures in children. J Trauma. 2002;52(3):504-16. doi: 10.1097/00005373-200203000-00015.

[17] 17.Aronson J, Tursky EA. External fixation of femur fractures in children. J Pediatr Orthop. 1992;12(2):157-63. doi: 10.1097/01241398-199203000-00003.

[18] 18.Krettek C, Haas N, Walker J, Tscherne H. Treatment of femoral shaft fractures in children by external fixation. Injury. 1991;22(4):263-66. doi: 10.1016/0020-1383(91)90002-v.

[19] 19.Ligier JN, Metaizeau JP, Prevot J, Lascombes P. Elastic stable intramedullary nailing of femoral shaft fractures in children. J Bone Joint Surg Br. 1988;70:74-7.

[20] 20.Flynn JM, Luedtke LM, Theodore J, et al. Comparison of titanium elastic nails with traction and a spica cast to treat femoral fractures in children. J Bone Joint Surg Am. 2004;86(4):770-7. doi: 10.2106/00004623-200404000-00015.

RIGHTS & PERMISSIONS

Khanna M., Wadhwani J., Batra A., Yadav S., Iman S., Vashishth S.