Effectiveness comparison of titanium elastic nail and locking compression plate fixation in treating femoral subtrochanteric fractures in older children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Xuepeng ,  LU Xiaobo , LUO Leiming , ZHANG Xihai , WANG Yuanhui

Department of Bone and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;

Corresponding?author：

LU Xiaobo, Email: lux90366@126.com

Keywords：

Titanium elastic nail; locking compression plate; femoral subtrochanteric fracture; older children

DOI：

10.7507/1002-1892.201704122

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Objective To compare the effectiveness of titanium elastic nail (TEN) and locking compression plate fixation in treating femoral subtrochanteric fracture in older children. Methods Between April 2015 and September 2016, 35 older children (aged 7-13 years) with femoral subtrochanteric fractures were treated, the clinical data were retrospectively reviewed. TEN fixation was used in 19 cases (group A) and locking compression plate fixation in 16 cases (group B). There was no significant difference in age, gender, sides, fracture causes, type of fracture, and time from injury to operation between 2 groups (P>0.05). The fluoroscopy times, operation time, intraoperative blood loss, fracture healing time were recorded and compared between 2 groups. The limb function was evaluated according to the Sanders scores and Flynnet al. outcome score. Results All the patients were followed up 6-24 months (mean, 11.46 months). The operation time, intraoperative blood loss, and fracture healing time of group A were significantly less than those of group B, but the fluoroscopy times of group A was significantly more than that of group B (P<0.05). All the fractures were healed, no breakage of screw, infection of deep tissue, nerve injury, osteonecrosis of the femoral head, or other complication occurred. At last follow-up, according to the Sanders scores, the results were excellent in 14 cases, good in 4 cases, and fair in 1 case in group A with an excellent and good rate of 94.74%; the results were excellent in 12 cases, good in 3 cases, and fair in 1 case in group B with an excellent and good rate of 93.75%; showing no significant difference between 2 groups (χ²=0.400, P=0.980). According to the Flynn et al. outcome score, the results were excellent in 13 cases, good in 5 cases, and fair in 1 case in group A with an excellent and good rate of 94.74%; the results were excellent in 11 cases, good in 3 cases, and fair in 2 cases in group B with an excellent and good rate of 87.50%; showing no significant difference between 2 groups (χ²=0.748, P=0.688). Conclusion Both TEN and locking compression plate have satisfactory outcomes for treating pediatric femoral subtrochanteric fractures. TEN method has minimally trauma, security, and faster fracture healing when compared with locking compression plate.

Citation： XU Xuepeng, LU Xiaobo, LUO Leiming, ZHANG Xihai, WANG Yuanhui. Effectiveness comparison of titanium elastic nail and locking compression plate fixation in treating femoral subtrochanteric fractures in older children. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(10): 1184-1189. doi: 10.7507/1002-1892.201704122 Copy

1.	Segal LS. Custom 95 degree condylar blade plate for pediatric subtrochanteric femur fractures. Orthopedics, 2000, 23(2): 103-107.
2.	曹啟斌, 舒鈞, 浦波. 股骨轉子下骨折手術治療及分型進展. 中國矯形外科雜志, 2012, 20(10): 906-908.0.
3.	徐蘊嵐, 沈愷穎, 王志剛. 彈性髓內釘在兒童長骨干骺交界區骨折中的治療體會. 中國矯形外科雜志, 2016, 24(16): 1455-1461.0.
4.	從先銳. 彈性髓內釘治療兒童股骨干骨折. 實用骨科雜志, 2014, 20(8): 749-751.0.
5.	鄒聯銀, 廖群英, 邱繼明. 兒童股骨干骨折手術治療的體會. 中國臨床研究, 2014, 6(23): 121-122.0.
6.	Hediu H, Larsson S. Technique and considerations when using external fixation as a standard treatment of femoral fractures in children. Injury, 2004, 35(12): 1255-1263.
7.	Jauquier N, Doerfler M, Haecker FM, et al. Immediate hip spica is as effective as,but more efficient than, flexible intramedullary nailing for femoral shaft fractures in pre-school children. J Child Orthop, 2010, 4(5): 461-465.
8.	Seinshimer F. Subtrochanteric fractures of the femur. J Bone Joint Surg (Am), 1978, 60(3): 300-306.
9.	Wainwright AM, Narayanan UG. A new technique for reduction of pediatric femoral fractures using elastic stable intramedullary nails. Ann R Coll Surg Engl, 2007, 89(4): 432-434.
10.	Sanders R, Regazzoni P, Routt ML Jr. The treatment of subtrochanteric fractures of the femur using the dynamic condylar screw. American Academy of Orthopaedic Surgeons Annual Meeting, Atlanta, 1988.
11.	Flynn JM, Skaggs D, Sponseller PD, et al. The Surgical management of pediatric fracture of the lower extremeity. Instr Coume Lect, 2003, 52: 647-659.
12.	Jarvis J, Davidson D, Letts M. Management of subtrochanteric fracture in skeletally immature adolescents. J Trauma, 2006, 60(3): 613-619.
13.	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.
14.	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.
15.	周宏艷, 左玉明, 趙洪波, 等. 彈性髓內釘治療兒童股骨粗隆下骨折的療效分析. 中國骨與關節損傷雜志, 2012, 27(6): 535-536.0.
16.	Saseendar S, Menon J, Patro DK. Treatment of femoral fractures in children: is titanium elastic nailing an improvement over hip spica casting. J Child Orthop, 2010, 4(3): 245-251.
17.	Mavrogenis AF, Mavrogenis G, Stavropoulos NA, et al. Sliding screw implants for extracaps-ular hip fractures. J Long Term Eft Med Implants, 2012, 22(1): 1-10.
18.	Parikh SN, Nathan ST, Priola MJ, et al. Elastic nailing for pediatric subtrochanteric and supraco- ndylar femur fractures. Clin Orthop Relat Res, 2014, 472(9): 2735-2744.
19.	邱建雄, 楊勇剛, 王華佚. 彈性髓內針治療兒童股骨骨折. 生物骨科材料與臨床研究, 2015, 12(1): 78-79.0.
20.	張葉. 彈性髓內釘治療兒童股骨骨折的臨床應用價值探析. 國際醫藥衛生導報, 2015, 21(5): 654-657.0.
21.	雷賽云, 譚文甫, 符勇. 彈性髓內釘治療兒童長骨骨折 25 例臨床分析. 中國骨與關節外科, 2014, 7(1): 59-61.0.
22.	Watson TJ, Wiss DA. Fracture of the proximal tibia and fibula//Tornetta P, Court-Brown CM, Heckman JD, et al. Rockwood and Grenn’s Fracture in adults. 8th eds. Philadelphia: Lippincott Williams and Wilkins, 2014: 1801-1842.
23.	Ellis HB, Ho CA, Podeszwa DA, et al. A comparison of locked versus nonlocked enders rods for length unstable pediatric femoral shaft fractures. J Pediatr Orthop, 2011, 31(8): 825-833.
24.	Fyodorov I, Sturm PF, Robertson, et al. Compression-plate fixation of femoral shaft fractures in children aged 8 to 12 years. J Pediatr Orthop, 1999, 19(5): 578-581.
25.	Narayanan UG, Hyman JE, Wainwright AM, et al. Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures,and how to avoid them. J Pediatr Orthop, 2004, 24(4): 363-369.
26.	羅雷茗, 魯曉波, 伍維, 等. 閉合與切開復位彈性髓內釘內固定治療兒童股骨粗隆下骨折療效比較. 中國修復重建外科雜志, 2015, 29(11): 1337-1341.0.

1. Segal LS. Custom 95 degree condylar blade plate for pediatric subtrochanteric femur fractures. Orthopedics, 2000, 23(2): 103-107.
2. 曹啟斌, 舒鈞, 浦波. 股骨轉子下骨折手術治療及分型進展. 中國矯形外科雜志, 2012, 20(10): 906-908.0.
3. 徐蘊嵐, 沈愷穎, 王志剛. 彈性髓內釘在兒童長骨干骺交界區骨折中的治療體會. 中國矯形外科雜志, 2016, 24(16): 1455-1461.0.
4. 從先銳. 彈性髓內釘治療兒童股骨干骨折. 實用骨科雜志, 2014, 20(8): 749-751.0.
5. 鄒聯銀, 廖群英, 邱繼明. 兒童股骨干骨折手術治療的體會. 中國臨床研究, 2014, 6(23): 121-122.0.
6. Hediu H, Larsson S. Technique and considerations when using external fixation as a standard treatment of femoral fractures in children. Injury, 2004, 35(12): 1255-1263.
7. Jauquier N, Doerfler M, Haecker FM, et al. Immediate hip spica is as effective as,but more efficient than, flexible intramedullary nailing for femoral shaft fractures in pre-school children. J Child Orthop, 2010, 4(5): 461-465.
8. Seinshimer F. Subtrochanteric fractures of the femur. J Bone Joint Surg (Am), 1978, 60(3): 300-306.
9. Wainwright AM, Narayanan UG. A new technique for reduction of pediatric femoral fractures using elastic stable intramedullary nails. Ann R Coll Surg Engl, 2007, 89(4): 432-434.
10. Sanders R, Regazzoni P, Routt ML Jr. The treatment of subtrochanteric fractures of the femur using the dynamic condylar screw. American Academy of Orthopaedic Surgeons Annual Meeting, Atlanta, 1988.
11. Flynn JM, Skaggs D, Sponseller PD, et al. The Surgical management of pediatric fracture of the lower extremeity. Instr Coume Lect, 2003, 52: 647-659.
12. Jarvis J, Davidson D, Letts M. Management of subtrochanteric fracture in skeletally immature adolescents. J Trauma, 2006, 60(3): 613-619.
13. 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.
14. 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.
15. 周宏艷, 左玉明, 趙洪波, 等. 彈性髓內釘治療兒童股骨粗隆下骨折的療效分析. 中國骨與關節損傷雜志, 2012, 27(6): 535-536.0.
16. Saseendar S, Menon J, Patro DK. Treatment of femoral fractures in children: is titanium elastic nailing an improvement over hip spica casting. J Child Orthop, 2010, 4(3): 245-251.
17. Mavrogenis AF, Mavrogenis G, Stavropoulos NA, et al. Sliding screw implants for extracaps-ular hip fractures. J Long Term Eft Med Implants, 2012, 22(1): 1-10.
18. Parikh SN, Nathan ST, Priola MJ, et al. Elastic nailing for pediatric subtrochanteric and supraco- ndylar femur fractures. Clin Orthop Relat Res, 2014, 472(9): 2735-2744.
19. 邱建雄, 楊勇剛, 王華佚. 彈性髓內針治療兒童股骨骨折. 生物骨科材料與臨床研究, 2015, 12(1): 78-79.0.
20. 張葉. 彈性髓內釘治療兒童股骨骨折的臨床應用價值探析. 國際醫藥衛生導報, 2015, 21(5): 654-657.0.
21. 雷賽云, 譚文甫, 符勇. 彈性髓內釘治療兒童長骨骨折 25 例臨床分析. 中國骨與關節外科, 2014, 7(1): 59-61.0.
22. Watson TJ, Wiss DA. Fracture of the proximal tibia and fibula//Tornetta P, Court-Brown CM, Heckman JD, et al. Rockwood and Grenn’s Fracture in adults. 8th eds. Philadelphia: Lippincott Williams and Wilkins, 2014: 1801-1842.
23. Ellis HB, Ho CA, Podeszwa DA, et al. A comparison of locked versus nonlocked enders rods for length unstable pediatric femoral shaft fractures. J Pediatr Orthop, 2011, 31(8): 825-833.
24. Fyodorov I, Sturm PF, Robertson, et al. Compression-plate fixation of femoral shaft fractures in children aged 8 to 12 years. J Pediatr Orthop, 1999, 19(5): 578-581.
25. Narayanan UG, Hyman JE, Wainwright AM, et al. Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures,and how to avoid them. J Pediatr Orthop, 2004, 24(4): 363-369.
26. 羅雷茗, 魯曉波, 伍維, 等. 閉合與切開復位彈性髓內釘內固定治療兒童股骨粗隆下骨折療效比較. 中國修復重建外科雜志, 2015, 29(11): 1337-1341.0.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness comparison of titanium elastic nail and locking compression plate fixation in treating femoral subtrochanteric fractures in older children

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