Sat., 10/18/08 Foot & Ankle/Pediatrics, Paper #65, 12:23 pm OTA-2008
Comparison of Flexible Nails versus Plating for Pediatric Diaphyseal Fractures
Clifford B. Jones, MD1 (a-Medtronic Sofamor Danek; e-Zimmer);
Debra L. Sietsema, PhD1 (d-Stryker); William D. Tressel, BS2 (n);
James R. Ringler, MD1 (n); Terrence J. Endres, MD1 (n);
1Orthopaedic Associates of Grand Rapids, Grand Rapids, Michigan, USA;
2Michigan State University/Grand Rapids Medical Education and Research Center,
Grand Rapids, Michigan, USA
Purpose: Pediatric femoral diaphyseal fractures can be treated with a myriad of options; flexible nailing (FN) and femoral plating (FP) are two mainstay treatments. The purpose of this study was to compare the outcomes of FN and FP.
Methods: Over a 7-year span (1999-2005), 168 consecutive unstable displaced pediatric (≤16 years) femoral diaphyseal fractures were treated with either FN (56 [33%]) or FP (112 [67%]) and analyzed with a retrospective chart review. With FN, 8 were performed open and 48 closed. With FP, 78 were performed percutaneously with relative stability while 34 were open with rigid fixation.
Results: Males (89) outnumbered females (37). Most children were from a two-parent setting (66%). Most children had commercial insurance (56%). The most common comorbidity was attention deficit hyperactivity disorder (8%). 11 fractures were open. The most common mechanism was motor vehicle accident (23%), followed by sports (15%), fall (14%), and pedestrian (13%). Associated injuries were common (51%). Time to weight bearing was 2 to 6 weeks (46%), with callus developing at 2 to 6 weeks (66%) and healing noted by 6 to 12 weeks (57%). Most patients (61%) did not receive any therapy. Hardware removal varied from 3 months to never without refracture or complications. Limp (52%) and pain (85%) was resolved by 3 months. 98% returned to activities of daily living. Only 16 children (12%) had complications as noted: scar (4), asymptomatic limb-length discrepancy >5 mm (3 FP, 2 FN), infection (2 FP, 2 FP), angulation >5° (2 FP, 6 FN), and hardware prominence (2). Although infrequent, FN had more technical complications while FP had more soft-tissue complications. FN had earlier time to weight bearing and hardware removal (P <0.05). Percutaneous bridge plating trended toward earlier callus formation. No statistical significance existed when comparing FN and FP in regard to age, limp, or pain.
Conclusion and Significance: If performed well, FN and FP provide efficient methods of stabilizing pediatric femoral diaphyseal fractures. FN had more technical complications, while FP had more soft-tissue complications. Percutaneous techniques result in quicker radiographic healing and potentially weight-bearing/rehabilitation. Hardware removal resulted in no refractures or perioperative complications. Asymptomatic limb-length discrepancy was uncommon with either FN or FP.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.