Session VII - Pediatrics

Saturday, October 10, 1998 Session VII, 7:36 a.m.

Ender Rod Fixation for Pediatric Femur Fractures

Kathryn E. Cramer, MD; Paul Tornetta, III, MD; Charles R. Spero, MD; Steven Alter; Hamid Maraliakbar; Jon Teefey, Henry Ford Hospital, Detroit, MI; SUNY Health Science Center, Brooklyn, NY

Purpose and Method: The use of Ender rod fixation in pediatric femur fractures was prospectively studied. Criteria for inclusion in the study included: age <14 years, femoral shaft fracture occurring in the middle three-fifths, canal size of >7 mm, and parental consent.

Fifty-six fractures in 52 patients between the ages of 5­14 years were evaluated. There were 14 girls and 38 boys, 2 girls and 2 boys had bilateral fractures. Thirteen involved the proximal third, 40 the middle third, and 3 the distal third. Fifty-four fractures were closed, while two were graded IIIA.

Results: Followup ranged from 6­50 months (avg. 20 months), with all but 4 patients having been followed at least one year. Time to full weight-bearing averaged 30 days for the children with unilateral injuries. Fifty-two fractures had no angulation at final followup, 4 fractures had <15 degrees of angulation in any plane, and rotation was within 10 degrees of the contralateral side in all cases. Clinically significant leg-length discrepancy (>2 cm) did not occur. All of the children followed for more than 12 months returned to their previous level of functioning and activities. Complications included five cases of increased comminution; in only one case was postoperative management altered. Three patients had temporary inflammatory reactions at the insertion sites, which resolved with local wound care; two locking screws broke and were easily retrieved at the time of hardware removal.

Discussion and Conclusion: Operative treatment for pediatric femur fractures is becoming well accepted. Options for fixation include external fixation, plating, and antegrade locked nailing, all of which have specific related potential complications.

Ender rod fixation in the pediatric population is simple, effective, and minimally invasive. It allows stable fixation, rapid healing, and a prompt return of the child to normal activity. Functional results are excellent and complications minor. The use of Ender rod fixation in pediatric femur fractures allows the advantages of surgical fixation without many of the risks associated with other techniques.