Close Versus Limited Open Method of Ender’s Nail Fixation in Paediatric Femoral Shaft Fractures

Authors

  • Rajeev Dwivedi Department of Orthopaedics ,Lumbini Medical College Teaching Hospital ,Tansen Palpa ,Nepal.
  • Shambu Sah Department of Orthopaedics, Koshi Zonal Hospital, Biratnagar, Koshi, Nepal.
  • Mukund Dahal Department of Orthopaedics, Koshi Zonal Hospital, Biratnagar, Koshi, Nepal.
  • Parimal Acharya Department of Orthopaedics, Civil Service Hospital, Kathmandu, Nepal.
  • Sandeep Gurung Department of Orthopaedics, Nepalgunj Medical College, Kohalpur, Nepal.

DOI:

https://doi.org/10.31729/jnma.2756

Keywords:

children; close technique; ender’s nail; fracture shaft of femur; flynn criteria.

Abstract

Introduction: There are various surgical options for treating fracture of femoral shaft in children. Here we compare the results of close with limited open method of Ender’s nails fixation of femoral shaft fractures in children.

Methods: We studied 60 children with femoral shaft fractures in age group 5-15 years. Ender’s nail fixation was done by close technique in 40 cases and in 20 cases by limited open technique.

Results: The mean operative time was significantly high in limited open group being 64 minutes in comparison to 50 minutes in close group. There was no significant difference between close and limited open groups with respect to time for partial weight bearing and time for full weight bearing. Fracture united sooner in close group as compared to open group. Union was achieved in all patients within a mean of 11 weeks in close group in comparison to 12.4 weeks in open group. According to the Flynn criteria in close group 34 patients had excellent results, 6 had satisfactory and none poor. In limited open group outcome was excellent in 14 patients, satisfactory in 4 patients and 2 had poor result. There was no significant difference in outcome based on Flynn criteria between two groups.

Conclusions: Though operative time is more and healing is delayed in Ender’s nail fixation by limited open technique, there is no statistical difference in final outcome as per Flynn criteria between close and limited open technique of Ender’s nail fixation of femoral shaft fractures in children. 

Keywords: children; close technique; ender’s nail; fracture shaft of femur; flynn criteria.

References

Flynn JM, Schwend RM. Management of pediatric femoral
shaft fractures. J Am Acad Orthop Surg. 2004;12(5):347-9.
2. Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson
R, Kasser J. 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.
3. Winquist RA, Hansen ST Jr. Comminuted fractures of the
femoral shaft treated by intramedullary nailing. Orthop Clin
Nort Am. 1980;11:633-48.
4. Mazda K, Khairouni A, Pennecot GF et al. Closed flexible
intramedullary nailing of the femoral shaft fractures in
children. J Pediatr Orthop. 1997;6:198-202.
5. Gregory P, Sullivan JA, Hernodon WA. Adolescent femoral
shaft fractures: rigid versus flexible nails. Orthopedics.
1995;18:645-9.
6. Gregory P, Pevny T, Teaque D. Early complications with
external fixation of paediatric femoral shaft fractures. J
Orthop Trauma. 1996;10:191-8.
7. Lee S, Mahar AT, Newton PO. Ender nail fixation of pediatric
femur fractures a biomechanical analysis. J Pediatr Orthop.
2001:Jul-Aug;21(4):42-5.
8. Yamaji T, Anodo K, Nakamura T, Washimi O, Terada N,
Yamada H. Femoral shaft fracture callus formation after
intramedullary nailing a comparison of interlocking and
Ender nailing. J Orthop Sci . 2002;7(4):472-6.
9. Mann DC, Weddington J, Davenport K. Closed Ender nailing
of femoral shaft fractures in adolescents. J Pediatr Orthop.
1986:Nov-Dec;6(6):651-5.
10. KaraoÄŸlu S, Baktir A, Tuncel M, KarakaÅŸ ES, Sakir TM.
Closed Ender nailing of adolescent femoral shaft fractures.
Injury. 1994:Oct;25(8):501-6.
11. Ozturkmen Y,Dogrul C,Karli M. intramedullary fixation of
femoral shaft fractures in children with elastic Enders nail.
Acta Orthop traumatol turc. 2002;36(3):220-7.
12. Shekhar L, Mayanger J C. A clinical study of Ender nails
fixation in femoral shaft fractures in children. Indian J
Orthop. 2006;40:35-7.
13. Kumar S, Roy SK, Jha AK, Chatterjee D, Banerjee D, Garg
AK. An evaluation of flexible intramedullary nail fixation in
femoral shaft fractures in paediatric age group. J Indian Med
Assoc. 2011 Jun;109(6):416-7
14. Lohiya R , Bachhal V , Khan U , Kumar D , Vijayvargiya
V , Sankhala S, Bhargava R and Jindal N. Flexible
intramedullary nailing in paediatric femoral fractures. A
report of 73 cases. Journal of Orthopaedic Surgery and
Research. 2011:6:6

Downloads

How to Cite

Dwivedi, R., Sah, S., Dahal, M., Acharya, P., & Gurung, S. (2014). Close Versus Limited Open Method of Ender’s Nail Fixation in Paediatric Femoral Shaft Fractures. Journal of Nepal Medical Association, 52(194), 806–810. https://doi.org/10.31729/jnma.2756

Issue

Section

Original Article