EFFECTIVENESS COMPARISON BETWEEN OPEN AND CLOSED REDUCTION USING ELASTIC STABLE INTRAMEDULLARY NAILING FOR PEDIATRIC SUBTROCHANTERIC FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LUOLeiming ¹ ,  LUXiaobo ¹ , WUWei ² , WANGYuanhui ¹ , GEJianhua ¹

1. Department of Bone and Joint Surgery, the Affiliated Hospital of Sichuan Medical University, Luzhou Sichuan, 646000, P. R. China;
2. the First Department of Orthopedics, Emei City Hospital of Traditional Chinese Medicine;

Corresponding?author：

LUXiaobo, Email: lux90366@126.com

Keywords：

Subtrochanteric fracture; Elastic stable intermedullary nailing; Internal fixation; Closed reduction; Open reduction; Child

DOI：

10.7507/1002-1892.20150289

Video：

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Objective To compare the effectiveness between open reduction and closed reduction of pediatric subtrochanteric fractures using elastic stable intramedullary nailing (ESIN). Methods Between January 2010 and January 2014, 22 children with subtrochanteric fractures were treated by ESIN internal fixation combined with hip cast fixation, and the clinical data were retrospectively reviewed. Closed reduction was used in 12 cases (group A) and miniopen reduction in 10 cases (group B). There was no significant difference in gender, age, sides, fracture causes, type of fracture, complications, and time from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, fracture healing time, and complications were recorded and compared between 2 groups, the limb function was evaluated according to the Flynn et al. outcome score. Results The intraoperative blood loss of group A was significantly less than that of group B, but the operation time of group A was significantly longer than that of group B (P<0.05). All the patients were followed up 12-36 months (mean, 14.9 months). There was no major complications in the other patients of both groups except 1 patient having delayed wound healing in group B. There was no significant difference in fracture healing time between 2 groups (t=-1.006, P=0.327). Inverted angle of 10° and shortened limb of 1.8 cm were observed in 1 case of group A, and sagittal plane angle of 15° and shortened limb of 2 cm in 1 case of group B. There was no abnormal walking and function of hip and knee activity at last follow-up. According to the Flynn et al. outcome score, the results were excellent in 8 cases and good in 4 cases in group A, and were excellent in 6 cases and good in 4 cases in group B, showing no significant difference between 2 groups (χ²=0.041, P=0.956). Conclusion Both closed and open fracture reduction using ESIN have satisfactory outcomes for treating pediatric subtrochanteric fractures. A mini-open reduction should be selected intraoperatively if closed reduction proves to be difficult.

Citation： LUOLeiming, LUXiaobo, WUWei, WANGYuanhui, GEJianhua. EFFECTIVENESS COMPARISON BETWEEN OPEN AND CLOSED REDUCTION USING ELASTIC STABLE INTRAMEDULLARY NAILING FOR PEDIATRIC SUBTROCHANTERIC FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(11): 1337-1341. doi: 10.7507/1002-1892.20150289 Copy

1.	Parikh SN, Nathan ST, Priola MJ, et al. Elastic nailing for pediatric subtrochanteric and supracondylar femur fractures. Clin Orthop Relat Res, 2014, 472(9):2735-2744.
2.	譚家昌, 楊有猛, 徐鴻育, 等. 改良彈性髓內釘技術治療兒童股骨轉子下骨折. 中國骨傷, 2013, 26(7):605-607.
3.	Flynn JM, Hresko T, Reynolds RA, et al. Titanium elastic nails for pediatric femur fractures:a multicenter study of early results with analysis of complications. J Pediatr Orthop, 2001, 21(1):4-8.
4.	Jeng C, Sponseller PD, Yates A, et al. Subtrochanteric femoral fractures in children. alignment after 90 degrees-90 degrees traction and cast application. Clin Orthop Relat Res, 1997, (341):170-174.
5.	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.
6.	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.
7.	蔡攀, 陸燕, 楊雷, 等. 保守與微創手術治療小兒轉子下骨折的放射學及臨床療效對比. 中國骨傷, 2009, 22(7):508-511.
8.	Eichinger JK, McKenzie CS, Devine JG. Evaluation of pediatric lower extremity fractures managed with external fixation:outcomes in a deployed environment. Am J Orthop (Belle Mead NJ), 2012, 41(1):15-19.
9.	Li Y, Heyworth BE, Glotzbecker M, et al. Comparison of titanium elastic nail and plate fixation of pediatric subtrochanteric femur fractures. J Pediatr Orthop, 2013, 33(3):232-238.
10.	Sanders S, Egol KA. Adult periarticular locking plates for the treatment of pediatric and adolescent subtrochanteric hip fractures. Bull NYU Hosp Jt Dis, 2009, 67(4):370-373.
11.	Cortes LE, Triana M, Vallejo F, et al. Adult proximal humerus locking plate for the treatment of a pediatric subtrochanteric femoral nonunion:a case report. J Orthop Trauma, 2011, 25(7):e63-67.
12.	Herrera-Soto JA, Meuret R, Phillips JH, et al. The management of pediatric subtrochanteric femur fractures with a statically locked intramedullary nail. J Orthop Trauma, 2015, 29(1):e7-e11.
13.	Slongo TF. Complications and failures of the esin technique. Injury, 2005, 36 Suppl 1:A78-85.
14.	Salonen A, Lahdes-Vasama T, Mattila VM, et al. Pitfalls of femoral titanium elastic nailing. Scand J Surg, 2015, 104(2):121-126.
15.	Fernandez FF, Langendorfer M, Wirth T, et al. Failures and complications in intramedullary nailing of children's forearm fractures. J Child Orthop, 2010, 4(2):159-167.
16.	Lascombes P, Nespola A, Poircuitte JM, et al. Early complications with flexible intramedullary nailing in childhood fracture:100 cases managed with precurved tip and shaft nails. Orthop Traumatol Surg Res, 2012, 98(4):369-375.
17.	Nisar A, Bhosale A, Madan SS, et al. Complications of Elastic Stable Intramedullary Nailing for treating paediatric long bone fractures. J Orthop, 2013, 10(1):17-24.
18.	Semaan A, Klein T, Boemers TM, et al. Therapy of pediatric femoral fractures. Two versus three elastic stable intramedullary nails. Unfallchirurg, 2015, 118(1):42-47.

1. Parikh SN, Nathan ST, Priola MJ, et al. Elastic nailing for pediatric subtrochanteric and supracondylar femur fractures. Clin Orthop Relat Res, 2014, 472(9):2735-2744.
2. 譚家昌, 楊有猛, 徐鴻育, 等. 改良彈性髓內釘技術治療兒童股骨轉子下骨折. 中國骨傷, 2013, 26(7):605-607.
3. Flynn JM, Hresko T, Reynolds RA, et al. Titanium elastic nails for pediatric femur fractures:a multicenter study of early results with analysis of complications. J Pediatr Orthop, 2001, 21(1):4-8.
4. Jeng C, Sponseller PD, Yates A, et al. Subtrochanteric femoral fractures in children. alignment after 90 degrees-90 degrees traction and cast application. Clin Orthop Relat Res, 1997, (341):170-174.
5. 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.
6. 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.
7. 蔡攀, 陸燕, 楊雷, 等. 保守與微創手術治療小兒轉子下骨折的放射學及臨床療效對比. 中國骨傷, 2009, 22(7):508-511.
8. Eichinger JK, McKenzie CS, Devine JG. Evaluation of pediatric lower extremity fractures managed with external fixation:outcomes in a deployed environment. Am J Orthop (Belle Mead NJ), 2012, 41(1):15-19.
9. Li Y, Heyworth BE, Glotzbecker M, et al. Comparison of titanium elastic nail and plate fixation of pediatric subtrochanteric femur fractures. J Pediatr Orthop, 2013, 33(3):232-238.
10. Sanders S, Egol KA. Adult periarticular locking plates for the treatment of pediatric and adolescent subtrochanteric hip fractures. Bull NYU Hosp Jt Dis, 2009, 67(4):370-373.
11. Cortes LE, Triana M, Vallejo F, et al. Adult proximal humerus locking plate for the treatment of a pediatric subtrochanteric femoral nonunion:a case report. J Orthop Trauma, 2011, 25(7):e63-67.
12. Herrera-Soto JA, Meuret R, Phillips JH, et al. The management of pediatric subtrochanteric femur fractures with a statically locked intramedullary nail. J Orthop Trauma, 2015, 29(1):e7-e11.
13. Slongo TF. Complications and failures of the esin technique. Injury, 2005, 36 Suppl 1:A78-85.
14. Salonen A, Lahdes-Vasama T, Mattila VM, et al. Pitfalls of femoral titanium elastic nailing. Scand J Surg, 2015, 104(2):121-126.
15. Fernandez FF, Langendorfer M, Wirth T, et al. Failures and complications in intramedullary nailing of children's forearm fractures. J Child Orthop, 2010, 4(2):159-167.
16. Lascombes P, Nespola A, Poircuitte JM, et al. Early complications with flexible intramedullary nailing in childhood fracture:100 cases managed with precurved tip and shaft nails. Orthop Traumatol Surg Res, 2012, 98(4):369-375.
17. Nisar A, Bhosale A, Madan SS, et al. Complications of Elastic Stable Intramedullary Nailing for treating paediatric long bone fractures. J Orthop, 2013, 10(1):17-24.
18. Semaan A, Klein T, Boemers TM, et al. Therapy of pediatric femoral fractures. Two versus three elastic stable intramedullary nails. Unfallchirurg, 2015, 118(1):42-47.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS COMPARISON BETWEEN OPEN AND CLOSED REDUCTION USING ELASTIC STABLE INTRAMEDULLARY NAILING FOR PEDIATRIC SUBTROCHANTERIC FRACTURES

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