Journal of Musculoskeletal Trauma

Flexible Intramedullary Nailing in Children's Femoral Shaft Fractures: Yeo Hon Yun, Chang Ho Choi, Jae Hak Jung; J Korean Soc Fract 2003;16(3):385-391. Published online July 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.3.385

PURPOSE
We report a treatment result and the pros-cons of the flexible intramedullary nailing for femoral shaft fractures in children between the ages of 4 and 11 years.
MATERIALS AND METHODS
During the recent three years, 28 femoral shaft fractures in 27 consecutive pediatric patients were treated with flexible intramedullary nailing. We retrospectively reviewed their clinical and radiological records, followed-up for at least one year, in respects to the recovery of knee joint motion; time of weight bearing; time of fracture union; period of admission and rehabilitation; angular deformity and leg length discrepancy; and other complications.
RESULTS
In all children, the knee joint motion was rapidly recovered to near normal range within 2~4 weeks. Partial weight bearing with wearing functional brace was possible within 2~4 weeks, while full weight bearing without brace was started until 6~12 (average 8.4) weeks after the nailing. In the last follow-up radiographs, five cases (18%) showed an angular deformity in any direction of more than 5 degrees. Two children represented leg length discrepancy of more than 1 cm. Other complications were one fixation failure, and one deep soft tissue infection at the entry point of the nail.
CONCLUSION
We strongly recommend the flexible intramedullary nailing in this injury because the fixation is strong enough to permit early knee motion and weight bearing in orthosis, the fracture healing was so rapid without any case of delayed or nonunion, and the incidences of residual angular deformity and leg length discrepancy were significantly less than the nonoperative treatment.

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Comparison of Flexible Intramedullary Nailing with External Fixation in Pediatric Femoral Shaft Fractures
Do-Young Kim, Sung-Ryong Shin, Un-Seob Jeong, Yong-Wook Park, Sang-Soo Lee, Keun-Min Park
The Journal of the Korean Orthopaedic Association.2008; 43(1): 30. CrossRef

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Treatment of femoral diaphyseal fractures in children: Comparison between conservative treatment and retrograde flexible intramedullary nailing: Chang Wug Oh, Byung Chul Park, Joo Chul Ihn, Hyung Tae Soh, Seung Hoon Baek; J Korean Soc Fract 2002;15(2):292-298. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.292

Abstract PDF: PURPOSE
To compare clinical outcomes and complications between pediatric patients with femoral shaft fracture who had undergone conservative treatment and retrograde flexible intramedullary nailing.
MATERIALS AND METHODS
51 cases of 46 pediatric patients who had femoral shaft fracture were retrospectively studied. Hip spica cast was applied 3~6 weeks after traction in 24 cases of conservative treatment group and closed reduction and internal fixation with flexible nails were performed in 27 cases.
RESULT
Neither pain, limitation of joint motion, nor nonunion was reported in both groups. In radiologic evaluation, 4 cases of angulation more than 10 degrees were observed in conservative treatment group and none of surgical treatment group. In leg length discrepancy(LLD) over 10 mm, there was none in surgical treatment group, but 4 cases were seen in the conservative group. Two cases of limping were observed only in the conservative group. Mean time to weight bearing was earlier in surgical treatment group(7.5 weeks) than that in the conservative group(10.8 weeks).
CONCLUSION
As treatment of pediatric femoral shaft fracture, retrograde flexible intramedullary nailing had less complications such as LLD and angulation and enabled earlier rehabilitation than conservative treatment.

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Retrograde Flexible Intramedullary Nailing of Pediatric Femur Fractures: Chang Wug Oh, Byung Chul Park, Hyung Jin Park; J Korean Soc Fract 2001;14(2):272-277. Published online April 30, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.2.272

Abstract PDF

PURPOSE
This study was designed to evaluate the clinical effectiveness including bone union, leg length discrepancy, after retrograde flexible intramedullary nailing for pediatric femoral fractures. MATERIAL AND METHOD: Nineteen cases (18 patients) with femur fracture at the age of 4 to 10 years (mean age 6.7) have been followed up over the minimum of one year. Under imaging intensifier, the fracture was temporarily reduced with manual traction, and 1 or 2 flexible nails were inserted at medial and lateral side of distal femur above the distal epiphysis. After two weeks of immobilization with long leg splint, joint motion was permitted. At 6-8 weeks, partial weight bearing was permitted, and at 10- 12 weeks, full weight bearing was permitted.
RESULTS
Time to radiologic union averaged 10.9 weeks. Limb length discrepancy ranged from 7mm of shortening to 6mm of overgrowth(mean ; 1.1mm of overgrowth), but there was no severe limb length discrepancy over 10mm. As another complications, there were one case of limited motion of knee joint and one case of broken nail.
CONCLUSION
We found that retrograde flexible intramedullary nailing is a safe, effective treatment for acute femoral shaft fractures in skeletally immature patients.

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Treatment of Femoral Shaft Fracture with Interlocking Humeral Nail in Older Children and Adolescent
Kun-Bo Park, Hoon Park, Hyun-Woo Kim, Hui-Wan Park, Jae Young Roh
Journal of the Korean Fracture Society.2010; 23(2): 206. CrossRef

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Flexible Intramedullary Nailing for Femoral Shaft Fracture in Children: Kwang Pyo Jeon, Kyung Hoon Kang, Jin Il Kim, Dong Soo Kim, Hyung Koo Yoon, Chul Weon Kang; J Korean Soc Fract 1999;12(4):1051-1057. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.1051

Abstract PDF: PURPOSE
: In children, fractures of the femoral shaft have been traditionally treated by immobilization in a spica cast, either immediately or after a period in traction except open fracture or for patient with head injuries. More recently, there has been a growing trend towards surgical treatment with widening of the indications including isolated femoral fractures. To evaluate the clinical, radiological results of surgical treatment for femoral shaft fractures in children, we reviewed 13 cases of femoral shaft fractures in children treated with flexible intramedullary nailing and followed for more than 12 months. MATERIALS & METHODS : The average age of the patients was 11 years and 4 months(range 10- 14 years). The average follow-up period was 1 years and 3 months(range 1 years-1 years and 8 months)after surgery. 10 cases and 3 cases were inserted through antegrade and retrograde entry, RESULTS: No major complications were found except 1 intraoperative iatrogenic fracture and 2 postoperative bursitis ;all fractures were united and radiologic union was obtained at 9.5 weeks after surgery.
CONCLUSION
: The clinical results obtained using flexible intramedullary nails for the stabilization of femoral shaft fracture in children are comparable to non-operative treatment, but with less disruption to family life and a shorter hospitalization while achieving near anatomic alingment, maintaining lengh, and allowing early active motion at the hip and knee.

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