Titanium elastic nailing versus locking compression plating in school-aged pediatric subtrochanteric femur fractures

Abstract

The treatment of children between 5 and 12 years of age suffering from subtrochanteric femoral fracture is challenging. The optimal choice of internal fixation for these patients is controversial. The purpose of this study is to compare the outcomes and complications of titanium elastic nail and open reduction with plate fixation of subtrochanteric femur fractures in school-aged children.A total of 67 children aged 5 to 12 years with subtrochanteric femur fractures treated with titanium elastic nails or open plating were identified at our institution from January 2007 to December 2017. We retrospectively compared 39 children treated with titanium elastic nails with 28 children treated with open reduction and plate fixation. The data included age, sex, body weight, fracture pattern, operation time, blood loss, and length of hospitalization. The follow-up investigations included radiograph of pelvis, bilateral hip range of motion, bilateral femoral neck shaft angle, and length of lower extremity. The outcomes were classified according to Flynn classification as excellent, satisfactory, or poor. All the demographic characteristics were compared with statistical analyses.All 67 fractures united properly. No major postoperative complications were noted in both groups. No significant difference was found between the titanium elastic nail and open plating groups in terms of sex, fracture pattern, and length of hospitalization. We noted a significant difference between 2 groups in terms of age, weight, operation time, and blood loss. In total, we observed 24 excellent and 15 satisfactory results in the titanium elastic nail group, and 19 excellent results and 9 satisfactory results in the open plating group. There was no significant statistical difference between involved and uninvolved side of hip regarding range of motion and femoral neck shaft angle in both groups.Titanium elastic nail and pediatric hip plate fixation represent safe and effective methods in the treatment of subtrochanteric fractures in school-aged children. Titanium elastic nail internal fixation is a minimal invasive and simpler technique and suitable for young children of lower body weight. Open plate fixation is a more rigid fixation associated with a lower complication rate.

Figures

Figure 1

A 7.5-year-old male fell down from a height of 1 m. (A) AP and lateral radiographs of the left femur with long oblique unstable subtrochanteric fracture. (B) Immediate postoperative radiographs after closed reduction and fixation with TENs. (C) Six months after surgery, the fracture had good healing radiographically. (D) AP view of pelvis showed a symmetric normal NSA between involved and uninvolved limb after 38 months.

Figure 2

A 7.6-year-old female suffered traffic accident. (A) Preoperative radiographs of the right femur with short oblique stable subtrochanteric fracture. (B) Immediate postoperative radiographs after closed reduction and fixation with 2 nails. (C) The bone healed well 6 months after surgery. (D) The patient showed a normal NSA (as on the uninvolved side) and a 1.5 cm limb length discrepancy with overgrowth of involved side.

Figure 3

A 6.8-year-old boy sustained an injury when falling from height. (A) Anteroposterior and lateral views of the left femur showed a short oblique stable subtrochanteric fracture. (B) The fracture was fixed with pediatric hip plate by open reduction. (C) Eight months after surgery, the fracture healed well and plate and screws were removed. (D) The patient showed a symmetric NSA. We noted a limb length inequality of -1 cm.

Figure 4

A 5.5-year-old boy suffered traffic accident. (A) AP and lateral radiographs of the right femur with comminuted unstable fracture of thesubtrochanteric region to shaft. (B) The patient was treated by open reduction with locking compression plate fixation. (C) Ten months after surgery, the fracture showed good healing radiographically and internal fixation was removed. (D) AP view of pelvis showed a symmetric NSA and no limb length inequality.