Effectiveness comparison of titanium elastic nail and locking compression plate fixation in treating femoral subtrochanteric fractures in older children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Xuepeng ,  LU Xiaobo , LUO Leiming , ZHANG Xihai , WANG Yuanhui

Department of Bone and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;

Corresponding author：

LU Xiaobo, Email: lux90366@126.com

Keywords：

Titanium elastic nail; locking compression plate; femoral subtrochanteric fracture; older children

DOI：

10.7507/1002-1892.201704122

Video：

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Objective To compare the effectiveness of titanium elastic nail (TEN) and locking compression plate fixation in treating femoral subtrochanteric fracture in older children. Methods Between April 2015 and September 2016, 35 older children (aged 7-13 years) with femoral subtrochanteric fractures were treated, the clinical data were retrospectively reviewed. TEN fixation was used in 19 cases (group A) and locking compression plate fixation in 16 cases (group B). There was no significant difference in age, gender, sides, fracture causes, type of fracture, and time from injury to operation between 2 groups (P>0.05). The fluoroscopy times, operation time, intraoperative blood loss, fracture healing time were recorded and compared between 2 groups. The limb function was evaluated according to the Sanders scores and Flynnet al. outcome score. Results All the patients were followed up 6-24 months (mean, 11.46 months). The operation time, intraoperative blood loss, and fracture healing time of group A were significantly less than those of group B, but the fluoroscopy times of group A was significantly more than that of group B (P<0.05). All the fractures were healed, no breakage of screw, infection of deep tissue, nerve injury, osteonecrosis of the femoral head, or other complication occurred. At last follow-up, according to the Sanders scores, the results were excellent in 14 cases, good in 4 cases, and fair in 1 case in group A with an excellent and good rate of 94.74%; the results were excellent in 12 cases, good in 3 cases, and fair in 1 case in group B with an excellent and good rate of 93.75%; showing no significant difference between 2 groups (χ²=0.400, P=0.980). According to the Flynn et al. outcome score, the results were excellent in 13 cases, good in 5 cases, and fair in 1 case in group A with an excellent and good rate of 94.74%; the results were excellent in 11 cases, good in 3 cases, and fair in 2 cases in group B with an excellent and good rate of 87.50%; showing no significant difference between 2 groups (χ²=0.748, P=0.688). Conclusion Both TEN and locking compression plate have satisfactory outcomes for treating pediatric femoral subtrochanteric fractures. TEN method has minimally trauma, security, and faster fracture healing when compared with locking compression plate.

Citation： XU Xuepeng, LU Xiaobo, LUO Leiming, ZHANG Xihai, WANG Yuanhui. Effectiveness comparison of titanium elastic nail and locking compression plate fixation in treating femoral subtrochanteric fractures in older children. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(10): 1184-1189. doi: 10.7507/1002-1892.201704122 Copy

1.	Segal LS. Custom 95 degree condylar blade plate for pediatric subtrochanteric femur fractures. Orthopedics, 2000, 23(2): 103-107.
2.	曹启斌, 舒钧, 浦波. 股骨转子下骨折手术治疗及分型进展. 中国矫形外科杂志, 2012, 20(10): 906-908.0.
3.	徐蕴岚, 沈恺颖, 王志刚. 弹性髓内钉在儿童长骨干骺交界区骨折中的治疗体会. 中国矫形外科杂志, 2016, 24(16): 1455-1461.0.
4.	从先锐. 弹性髓内钉治疗儿童股骨干骨折. 实用骨科杂志, 2014, 20(8): 749-751.0.
5.	邹联银, 廖群英, 邱继明. 儿童股骨干骨折手术治疗的体会. 中国临床研究, 2014, 6(23): 121-122.0.
6.	Hediu H, Larsson S. Technique and considerations when using external fixation as a standard treatment of femoral fractures in children. Injury, 2004, 35(12): 1255-1263.
7.	Jauquier N, Doerfler M, Haecker FM, et al. Immediate hip spica is as effective as,but more efficient than, flexible intramedullary nailing for femoral shaft fractures in pre-school children. J Child Orthop, 2010, 4(5): 461-465.
8.	Seinshimer F. Subtrochanteric fractures of the femur. J Bone Joint Surg (Am), 1978, 60(3): 300-306.
9.	Wainwright AM, Narayanan UG. A new technique for reduction of pediatric femoral fractures using elastic stable intramedullary nails. Ann R Coll Surg Engl, 2007, 89(4): 432-434.
10.	Sanders R, Regazzoni P, Routt ML Jr. The treatment of subtrochanteric fractures of the femur using the dynamic condylar screw. American Academy of Orthopaedic Surgeons Annual Meeting, Atlanta, 1988.
11.	Flynn JM, Skaggs D, Sponseller PD, et al. The Surgical management of pediatric fracture of the lower extremeity. Instr Coume Lect, 2003, 52: 647-659.
12.	Jarvis J, Davidson D, Letts M. Management of subtrochanteric fracture in skeletally immature adolescents. J Trauma, 2006, 60(3): 613-619.
13.	Pombo MW, Shilt JS. The definition and treatment of pediatric subtrochanteric femur fractures with titanium elastic nails. J Pediatr Orthop, 2006, 26(3): 364-370.
14.	Sink EL, Faro F, Polousky J, et al. Decreased complications of pediatric femur fractures with a change in management. J Pediatr Orthop, 2010, 30(7): 633-637.
15.	周宏艳, 左玉明, 赵洪波, 等. 弹性髓内钉治疗儿童股骨粗隆下骨折的疗效分析. 中国骨与关节损伤杂志, 2012, 27(6): 535-536.0.
16.	Saseendar S, Menon J, Patro DK. Treatment of femoral fractures in children: is titanium elastic nailing an improvement over hip spica casting. J Child Orthop, 2010, 4(3): 245-251.
17.	Mavrogenis AF, Mavrogenis G, Stavropoulos NA, et al. Sliding screw implants for extracaps-ular hip fractures. J Long Term Eft Med Implants, 2012, 22(1): 1-10.
18.	Parikh SN, Nathan ST, Priola MJ, et al. Elastic nailing for pediatric subtrochanteric and supraco- ndylar femur fractures. Clin Orthop Relat Res, 2014, 472(9): 2735-2744.
19.	邱建雄, 杨勇刚, 王华佚. 弹性髓内针治疗儿童股骨骨折. 生物骨科材料与临床研究, 2015, 12(1): 78-79.0.
20.	张叶. 弹性髓内钉治疗儿童股骨骨折的临床应用价值探析. 国际医药卫生导报, 2015, 21(5): 654-657.0.
21.	雷赛云, 谭文甫, 符勇. 弹性髓内钉治疗儿童长骨骨折 25 例临床分析. 中国骨与关节外科, 2014, 7(1): 59-61.0.
22.	Watson TJ, Wiss DA. Fracture of the proximal tibia and fibula//Tornetta P, Court-Brown CM, Heckman JD, et al. Rockwood and Grenn’s Fracture in adults. 8th eds. Philadelphia: Lippincott Williams and Wilkins, 2014: 1801-1842.
23.	Ellis HB, Ho CA, Podeszwa DA, et al. A comparison of locked versus nonlocked enders rods for length unstable pediatric femoral shaft fractures. J Pediatr Orthop, 2011, 31(8): 825-833.
24.	Fyodorov I, Sturm PF, Robertson, et al. Compression-plate fixation of femoral shaft fractures in children aged 8 to 12 years. J Pediatr Orthop, 1999, 19(5): 578-581.
25.	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): 363-369.
26.	罗雷茗, 鲁晓波, 伍维, 等. 闭合与切开复位弹性髓内钉内固定治疗儿童股骨粗隆下骨折疗效比较. 中国修复重建外科杂志, 2015, 29(11): 1337-1341.0.

1. Segal LS. Custom 95 degree condylar blade plate for pediatric subtrochanteric femur fractures. Orthopedics, 2000, 23(2): 103-107.
2. 曹启斌, 舒钧, 浦波. 股骨转子下骨折手术治疗及分型进展. 中国矫形外科杂志, 2012, 20(10): 906-908.0.
3. 徐蕴岚, 沈恺颖, 王志刚. 弹性髓内钉在儿童长骨干骺交界区骨折中的治疗体会. 中国矫形外科杂志, 2016, 24(16): 1455-1461.0.
4. 从先锐. 弹性髓内钉治疗儿童股骨干骨折. 实用骨科杂志, 2014, 20(8): 749-751.0.
5. 邹联银, 廖群英, 邱继明. 儿童股骨干骨折手术治疗的体会. 中国临床研究, 2014, 6(23): 121-122.0.
6. Hediu H, Larsson S. Technique and considerations when using external fixation as a standard treatment of femoral fractures in children. Injury, 2004, 35(12): 1255-1263.
7. Jauquier N, Doerfler M, Haecker FM, et al. Immediate hip spica is as effective as,but more efficient than, flexible intramedullary nailing for femoral shaft fractures in pre-school children. J Child Orthop, 2010, 4(5): 461-465.
8. Seinshimer F. Subtrochanteric fractures of the femur. J Bone Joint Surg (Am), 1978, 60(3): 300-306.
9. Wainwright AM, Narayanan UG. A new technique for reduction of pediatric femoral fractures using elastic stable intramedullary nails. Ann R Coll Surg Engl, 2007, 89(4): 432-434.
10. Sanders R, Regazzoni P, Routt ML Jr. The treatment of subtrochanteric fractures of the femur using the dynamic condylar screw. American Academy of Orthopaedic Surgeons Annual Meeting, Atlanta, 1988.
11. Flynn JM, Skaggs D, Sponseller PD, et al. The Surgical management of pediatric fracture of the lower extremeity. Instr Coume Lect, 2003, 52: 647-659.
12. Jarvis J, Davidson D, Letts M. Management of subtrochanteric fracture in skeletally immature adolescents. J Trauma, 2006, 60(3): 613-619.
13. Pombo MW, Shilt JS. The definition and treatment of pediatric subtrochanteric femur fractures with titanium elastic nails. J Pediatr Orthop, 2006, 26(3): 364-370.
14. Sink EL, Faro F, Polousky J, et al. Decreased complications of pediatric femur fractures with a change in management. J Pediatr Orthop, 2010, 30(7): 633-637.
15. 周宏艳, 左玉明, 赵洪波, 等. 弹性髓内钉治疗儿童股骨粗隆下骨折的疗效分析. 中国骨与关节损伤杂志, 2012, 27(6): 535-536.0.
16. Saseendar S, Menon J, Patro DK. Treatment of femoral fractures in children: is titanium elastic nailing an improvement over hip spica casting. J Child Orthop, 2010, 4(3): 245-251.
17. Mavrogenis AF, Mavrogenis G, Stavropoulos NA, et al. Sliding screw implants for extracaps-ular hip fractures. J Long Term Eft Med Implants, 2012, 22(1): 1-10.
18. Parikh SN, Nathan ST, Priola MJ, et al. Elastic nailing for pediatric subtrochanteric and supraco- ndylar femur fractures. Clin Orthop Relat Res, 2014, 472(9): 2735-2744.
19. 邱建雄, 杨勇刚, 王华佚. 弹性髓内针治疗儿童股骨骨折. 生物骨科材料与临床研究, 2015, 12(1): 78-79.0.
20. 张叶. 弹性髓内钉治疗儿童股骨骨折的临床应用价值探析. 国际医药卫生导报, 2015, 21(5): 654-657.0.
21. 雷赛云, 谭文甫, 符勇. 弹性髓内钉治疗儿童长骨骨折 25 例临床分析. 中国骨与关节外科, 2014, 7(1): 59-61.0.
22. Watson TJ, Wiss DA. Fracture of the proximal tibia and fibula//Tornetta P, Court-Brown CM, Heckman JD, et al. Rockwood and Grenn’s Fracture in adults. 8th eds. Philadelphia: Lippincott Williams and Wilkins, 2014: 1801-1842.
23. Ellis HB, Ho CA, Podeszwa DA, et al. A comparison of locked versus nonlocked enders rods for length unstable pediatric femoral shaft fractures. J Pediatr Orthop, 2011, 31(8): 825-833.
24. Fyodorov I, Sturm PF, Robertson, et al. Compression-plate fixation of femoral shaft fractures in children aged 8 to 12 years. J Pediatr Orthop, 1999, 19(5): 578-581.
25. 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): 363-369.
26. 罗雷茗, 鲁晓波, 伍维, 等. 闭合与切开复位弹性髓内钉内固定治疗儿童股骨粗隆下骨折疗效比较. 中国修复重建外科杂志, 2015, 29(11): 1337-1341.0.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness comparison of titanium elastic nail and locking compression plate fixation in treating femoral subtrochanteric fractures in older children

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