Indian Journal of Orthopaedics Surgery


Outcome of pediatric subtrochanteric femur fractures treated with titanium elastic nail


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Author Details: Ravindra Patil, Mohammed Abdul Azeem

Volume : 2

Issue : 4

Online ISSN : 2395-1362

Print ISSN : 2395-1354

Article First Page : 396

Article End Page : 401


Abstract

Background: Titanium elastic nailing system has been accepted as a standard modality of treatment for pediatric femur fracture in 5- 12 year age group with excellent results. Subset of patients with fracture in subtrochanteric and supracondylar region have shown higher rate of complications than shaft fractures when treated with titanium elastic nailing system. The purpose of the present study was to retrospectively evaluate the outcomes and complications of titanium elastic nail fixation of subtrochanteric femur fracture in children and young adolescents.
Methods: A total of 50 children aged between 5 to 12 years with subtrochanteric femur fracture treated with titanium elastic nail between 2010-2016 were identified. A fracture that was located within 10% of the total femur length below the lesser trochnater was classified as subtrochanteric fracture. We retrospectively evaluated the outcomes and complications using Flynn TEN scoring criteria. Outcomes were classified as excellent, satisfactory or poor. A major complication was defined as one which requires surgical intervention. Minor complications were defined as one which resolved without surgical intervention.
Results: The mean age of the study group was 7.9 yrs with 42 boys and 8 girls. 36(72%) fractures were length stable and 14(28%) were length unstable. 5(10%) had open fracture. Full weight bearing ambulation was achieved at an average of 6.6 weeks and radiological union at 10.7 weeks. Outcome results were excellent in 26(52%), satisfactory in 20 (40%) and poor in 4 (8%) patients. The major complications were seen in 4 (8%) patients and minor complications in 24 (48%) patients. Complication rate was higher for length unstable fractures than length stable fractures.
Conclusion: Our results indicate that subtrochanteric femur fractures treated with titanium elastic nail show excellent to satisfactory results in majority of patients, however minor complication rate in these fractures is pretty high, more so with length unstable subtrochanteric femur fractures.
Level of Evidence: Therapeutic level IV

Keywords
: Subtrochanteric femur fractures, Pediatric, Treatment, Titanium elastic nails