Session VIII - Pediatrics
Sat, 10/9/04 Pediatrics, Paper #44, 3:06 pm
Weight Greater than or Equal to 99 Pounds and Age Greater than or Equal to 12 Years Predict Malunion following Elastic Stable Intramedullary Nailing (Nancy Nailing) of Femoral Shaft Fractures in Children
Purpose: Elastic stable intramedullary nailing (ESIN) has emerged as the preferred method of surgical treatment for femoral shaft fractures in children. We sought to identify patient-related characteristics that would predict complications associated with this surgical approach.
Methods: A computerized medical records search identified all patients treated with ESIN of femoral shaft fractures between 1997 and 2002. Age-related criteria were used to define fracture malunion. Potential predictor variables included age, sex, weight, fracture type, and canal diameter-nail ratio (the "0.4 rule"). Statistical methods included chi-square and logistic regression analyses.
Results: The entire study group consisted of 101 patients whose average age was 9 years (range, 4 to 15). There were 76 male and 25 female patients with an average weight of 33 kg (range, 18 to 81). No clinically significant leg-length or rotational problems were identified. Two deep infections occurred. Seven patients underwent nail revision prior to complete fracture healing because of symptomatic implants. On the basis of our defined criteria, angular malunion occurred in 18 patients. Weight 99 lbs/45 kg (P = 0.05) and age 12 (P = 0.02) were predictive of fracture malunion.
Conclusion: The results of our study establish a statistically significant association between femoral shaft fracture angular malunion and heavier, older patients.
Significance: Other femoral shaft fracture treatment strategies should be considered for patients who exceed our stated weight and age criteria.