DOS BULLETIN - Dansk Ortopædisk Selskab

2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 90
Experience in treating unstable forearm and femur
fractures in children with elastic intramedullary nail
using T.... E.... N....
Bent Soloy, Steffen Skov
Regionshospitalet Viborg
Background: Unstable diaphyseal fractures of the forearm and femur in children
often require osteosynthesis. Fractures of the forearm is often treated with
k-wires or plating. Femur fractures can be treated with plaster-traction in smaller
children, but in bigger children internal or external fixation is required. The
use of elastic intramedullary nail is minimal invasive and seems to give sufficient
stability.
Purpose: To verify the good result from other international studies regarding
the use of TEN for forearm fractures, and present our result in femur fractures
Methods: We present our experience with TEN for unstable pediatric forearm
and femur fractures. 210 patients with forearm fractures were admitted to our
clinic between December 1998 and April 2010. 70 patients were treated with
TEN the rest were either treated with closed reduction, K-wire our plating. 46
patients with femur fractures were admitted to our clinic between December
1998 and April 2010. 22 patients were treated with TEN. All patients in both
groups were reviewed retrospectively. In the group with forearm fractures there
were 38 boys and 32 girls median age 8.3 years. All fixations were protected in
an above elbow plaster cast. Patients were followed up for an average of 4.2
months (range, 2-12 months). In the group with femur fractures there were 13
boys and 9 girls median age 6.9 years. All fixations were protected with a cast
until radiologic union. Patients were followed for an average of 8.5 months
(range 3.5-13 months).
Findings: In the forearm fractures, clinical and radiologic union was achieved
within 6 weeks after the procedure in 69 children. One patient was operated 1
day after the primary operation with a plat because of unacceptable angular
deformity. 5 patients had superficial pin infection after 6 Weeks and had their
TEN removed without any further complications. One patient had decreased
subination compared to the healty side 12 months after treated with TEN, but
no functional loss was reported. In the femur fractures clinical and radiologic
union was achieved within 12 weeks after the procedure in 21 children. One
patient was operated 2 days after primary operation with extern fixation because
of unstable osteosynthesis. Two patients had a nail removed after 6 weeks
because the nail irritated the skin. One patient had 2 cm leg shortening on the
operated side 12 months after operation. The patient is still followed once a year
to see if there will be problems with the leg.
Conclusion: Diaphyseal fractures of the forearm and femur in children can be
difficult to threat and often require osteosynthesis by internal or external fixation.
Since 1998 our department has used a elastic intramedullary nail, T... E...
N..., in these fractures with few complications and a god functionel result.
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