Treatment of Paediatric Femoral Fractures with a new Interlocked Flexible Nail

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Treatment of Paediatric Femoral Fractures with a
new Interlocked Flexible Nail

• Jonathan H Phillips, Bsc. MB.BS
• Lubica Jencikova-Celerin MD. PhD ,
• Lloyd Werk MD, Stacey Armatti Wiltrout,
• Ian Nathanson, MD.
• Arnold Palmer Hospital for Children and Nemours
  Childrens Clinic, Orlando Florida

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Introduction

• Optimal treatment of femoral shaft fractures in
  older children and adolescents remains
  controversial. We hypothesized that fixation
  with a flexible interlocking intramedullary nail
  (FIIN, Pediatric Locking Nail, Biomet, New
  Jersey) reduced peri-operative complications and
  improved outcomes compared to standard elastic
  nail implants and other fixation procedures (OFP).

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Methods

• Retrospective cohort study design
• Medical record and radiograph review of
  children, 7-18 years of age, with femoral shaft
  fractures requiring open treatment over 5 year
  period. Two different Centers
• Patients selected had unilateral fracture sites
  proximal to the supracondylar region and distal
  to the lesser trochanter.
• Analyses compared inpatient measures and patient
  outcomes between FIIN and OFP groups.

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Figure 1. Subject Enrollment
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Results

• 160 patients eligible for inclusion, 23 were lost
  to followup.
• The remaining 137 patients had a mean follow-up
  of 396.3 days (S.D. 320.4 days) with 58 receiving
  FIIN fixation and 79 OFP.
• Complications occurred in 19.0 of patients in
  the FIIN group and 30.4 in the OFP group (p
  0.130 )

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Results

• Trochanteric heterotopic ossification most common
  complication (13.8) noted in the FIIN group
  Superficial infection (12.8) in the OFP group.
• FIIN group experienced less blood loss (p0.042)
  and shorter time to weight bearing (p 0.001) No
  proximal femoral growth disturbance seen
• In children weighing lt 45.5 kg, complications
  less common with FIIN (3.6 ) compared to OFP
  (24.4 ). Subgroup of patients lt 45.5 kg with
  standard elastic nail implants (n 24) had 8.1
  times the complications of patients with FIIN.

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Table 3. Complications Among Patients Treated for
Femoral Shaft Fractures
FIIN flexible interlocking intramedullary
nail OFP other fixation procedures
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Early postoperative radiographs of spiral
proximal femoral fracture fixed with the
Paediatric Locking Nail
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AP radiograph at seven weeks, similar case to
previous one

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Conclusions

• Older children and adolescents with femoral shaft
  fractures treated with FIIN showed improved
  treatment outcomes compared to patients with OFP.
  Longer follow up will be needed to confirm these
  early results