TENS in Femoral Shaft Fractures of Children
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Abstract
Background: Pediatric femoral shaft fractures are one of the common fractures that we encounter in the orthopedics outpatient department. These fractures have various treatment options ranging from traction and early hip spica casting to elastic titanium intramedullary nails [titanium elastic nailing system (TENS)] and reamed intramedullary nails. In this study, we are evaluating the functional outcome and results following the use of flexible intramedullary nails and conservative management for femoral shaft fractures in children.
Methods: This was a prospective observational study which was carried out in a tertiary care hospital from October 2015 to May 2017 for two groups of children who sustained traumatic femoral shaft fractures. A total of 40 patients were taken into consideration with 20 patients each in two groups.
Results: The male-to-female ratio was 2.6:1 in our study population. The overall post-operative complication rate was more in the TENS group. Besides, we found that the TENS group of patients had a less limb length discrepancy (LLD) (P = 0.004) and a lower degree of angular deformity (P = 0.36).
Conclusion: TENS demonstrated advantages including sufficient axial stability, early mobilization, and more rapid return to function than spica cast treatment; however, it had the drawback of possible infection and pin site irritation. Overall, TENS offers a minimally invasive method for treatment of the femoral shaft fractures in children which stands superior to traditio nal spica casting.
1. Ramachandra K, Virupaksha Reddy SP, Gahlowt A, Akshay SD, Javali V, Remya, Sreekantha. A prospective study of management of pediatric femoral diaphyseal fractures using intramedullary titanium elastic nails. Int J Res Health Sci. 2015;3(1):11-7.
2. Flynn JM, Schwend RM. Management of pediatric femoral shaft fractures. J Am Acad Orthop Surg. 2004;12(5):347-59. doi: 10.5435/00124635-200409000-00009. [PubMed: 15469229].
3. Loder RT, O'Donnell PW, Feinberg JR. Epidemiology and mechanisms of femur fractures in children. J Pediatr Orthop. 2006;26(5):561-6. doi: 10.1097/01.bpo.0000230335.19029.ab. [PubMed: 16932091].
4. Scherl SA, Miller L, Lively N, Russinoff S, Sullivan CM, Tornetta P 3rd. Accidental and nonaccidental femur fractures in children. Clin Orthop Relat Res. 2000;(376):96-105. doi: 10.1097/00003086-200007000-00014. [PubMed: 10906863].
5. Fry K, Hoffer MM, Brink J. Femoral shaft fractures in brain- injured children. J Trauma. 1976;16(5):371-3. doi: 10.1097/00005373-197605000-00008. [PubMed: 1271499].
6. Hedlund R, Lindgren U. The incidence of femoral shaft fractures in children and adolescents. J Pediatr Orthop. 1986;6(1):47-50. doi: 10.1097/01241398-198601000-00010. [PubMed: 3941180].
7. Hinton RY, Lincoln A, Crockett MM, Sponseller P, Smith G. Fractures of the femoral shaft in children. Incidence, mechanisms, and sociodemographic risk factors. J Bone Joint Surg Am. 1999;81(4):500-9. doi: 10.2106/00004623-199904000-00007. [PubMed: 10225795].
8. Landin LA. Fracture patterns in children. Analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a Swedish urban population 1950-1979. Acta Orthop Scand Suppl. 1983;202:1-109. [PubMed: 6574687].
9. Lee SS, Mahar AT, Newton PO. Ender nail fixation of pediatric femur fractures: A biomechanical analysis. J Pediatr Orthop. 2001;21(4):442-5. [PubMed: 11433153].
10. Metaizeau JP. Stable elastic intramedullary nailing for fractures of the femur in children. J Bone Joint Surg Br. 2004;86(7):954-7. doi: 10.1302/0301-620x.86b7.15620. [PubMed: 15446516].
11. Carey TP, Galpin RD. Flexible intramedullary nail fixation of pediatric femoral fractures. Clin Orthop Relat Res. 1996;(332):110-8. doi: 10.1097/00003086-199611000-00015. [PubMed: 8913152].
12. Mishra AK, Chalise PK, Shah SB, Adhikari V, Singh RP. Diaphyseal femoral fractures in children treated with titanium elastic nail system. Nepal Med Coll J. 2013;15(2):95-7. [PubMed: 24696924].
13. Lee YH, Lim KB, Gao GX, Mahadev A, Lam KS, Tan SB, et al. Traction and spica casting for closed femoral shaft fractures in children. J Orthop Surg (Hong Kong). 2007;15(1):37-40. doi: 10.1177/230949900701500109. [PubMed: 17429115].
14. Heinrich SD, Drvaric DM, Darr K, MacEwen GD. The operative stabilization of pediatric diaphyseal femur fractures with flexible intramedullary nails: A prospective analysis. J Pediatr Orthop. 1994;14(4):501-7. doi: 10.1097/01241398-199407000-00016. [PubMed: 8077436].
15. Kirby RM, Winquist RA, Hansen ST. Femoral shaft fractures in adolescents: A comparison between traction plus cast treatment and closed intramedullary nailing. J Pediatr Orthop. 1981;1(2):193-7. [PubMed: 7334095].
16. Mann DC, Weddington J, Davenport K. Closed Ender nailing of femoral shaft fractures in adolescents. J Pediatr Orthop. 1986;6(6):651-5. doi: 10.1097/01241398-198611000-00002. [PubMed:
3793884].
17. Nascimento FP, Santili C, Akkari M, Waisberg G, Braga SR, Fucs PM. Flexible intramedullary nails with traction versus plaster cast for treating femoral shaft fractures in children: comparative retrospective study. Sao Paulo Med J. 2013;131(1): 5-12. doi: 10.1590/s1516-31802013000100002. [PubMed: 23538589].
18. Mazda K, Khairouni A, Pennecot GF, Bensahel H. Closed flexible intramedullary nailing of the femoral shaft fractures in children. J Pediatr Orthop B. 1997;6(3):198-202. doi: 10.1097/01202412-199707000-00008. [PubMed: 9260649].
19. Bar-On E, Sagiv S, Porat S. External fixation or flexible intramedullary nailing for femoral shaft fractures in children. A prospective, randomised study. J Bone Joint Surg Br. 1997;79(6): 975-8. doi: 10.1302/0301-620x.79b6.7740. [PubMed: 9393916].
20. Greisberg J, Bliss MJ, Eberson CP, Solga P, d'Amato C. Social and economic benefits of flexible intramedullary nails in the treatment of pediatric femoral shaft fractures. Orthopedics. 2002;25(10):1067-70. doi: 10.3928/0147-7447-20021001-18. [PubMed: 12401013].
21. Verma DP, Chandan RK, Meena RC, Sharma SL. Comparative study of titanium elastic nailing versus hip spica in treatment of femoral shaft fractures in children. IntJ Res Orthop. 2016;2(3):155-8. doi: 10.18203/issn.2455-4510.IntJResOrthop20163122.
22. Shemshaki HR, Mousavi H, Salehi G, Eshaghi MA. Titanium elastic nailing versus hip spica cast in treatment of femoral- shaft fractures in children. J Orthop Traumatol. 2011;12(1):45-8. doi: 10.1007/s10195-011-0128-0. [PubMed: 21340544]. [PubMed Central: PMC3052430].
23. Khaffaf R, Altaweel A. Comparative study between the elastic nail versus hip spica cast in early treatment of pediatric femoral shaft fractures. Open J Orthop. 2016; 6(9):259-67. doi: 10.4236/ojo.2016.69034.
24. Flynn J, Skaggs D, Sponseller P, Ganley T, Kay R, Leitch K. The operative management of pediatric fractures of the lower extremity. J Bone Joint Surg. 2002;84(12):2288-300. doi: 10.2106/00004623-200212000-00025.
25. Czertak DJ, Hennrikus WL. The treatment of pediatric femur fractures with early 90-90 spica casting. J Pediatr Orthop. 1999;19(2):229-32. doi: 10.1097/00004694-199903000-00018. [PubMed: 10088694].
26. Staheli LT. Femoral and tibial growth following femoral shaft fracture in childhood. Clin Orthop Relat Res . 1967;55:159-63. [PubMed: 6079747].
27. Herscovici D, Scott DM, Behrens F, Nelson B, Benton J. The use of Ender nails in femoral shaft fractures: what are the remaining indications? J Orthop Trauma. 1992;6(3):314-7. doi: 10.1097/00005131-199209000-00008. [PubMed: 1403250].
2. Flynn JM, Schwend RM. Management of pediatric femoral shaft fractures. J Am Acad Orthop Surg. 2004;12(5):347-59. doi: 10.5435/00124635-200409000-00009. [PubMed: 15469229].
3. Loder RT, O'Donnell PW, Feinberg JR. Epidemiology and mechanisms of femur fractures in children. J Pediatr Orthop. 2006;26(5):561-6. doi: 10.1097/01.bpo.0000230335.19029.ab. [PubMed: 16932091].
4. Scherl SA, Miller L, Lively N, Russinoff S, Sullivan CM, Tornetta P 3rd. Accidental and nonaccidental femur fractures in children. Clin Orthop Relat Res. 2000;(376):96-105. doi: 10.1097/00003086-200007000-00014. [PubMed: 10906863].
5. Fry K, Hoffer MM, Brink J. Femoral shaft fractures in brain- injured children. J Trauma. 1976;16(5):371-3. doi: 10.1097/00005373-197605000-00008. [PubMed: 1271499].
6. Hedlund R, Lindgren U. The incidence of femoral shaft fractures in children and adolescents. J Pediatr Orthop. 1986;6(1):47-50. doi: 10.1097/01241398-198601000-00010. [PubMed: 3941180].
7. Hinton RY, Lincoln A, Crockett MM, Sponseller P, Smith G. Fractures of the femoral shaft in children. Incidence, mechanisms, and sociodemographic risk factors. J Bone Joint Surg Am. 1999;81(4):500-9. doi: 10.2106/00004623-199904000-00007. [PubMed: 10225795].
8. Landin LA. Fracture patterns in children. Analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a Swedish urban population 1950-1979. Acta Orthop Scand Suppl. 1983;202:1-109. [PubMed: 6574687].
9. Lee SS, Mahar AT, Newton PO. Ender nail fixation of pediatric femur fractures: A biomechanical analysis. J Pediatr Orthop. 2001;21(4):442-5. [PubMed: 11433153].
10. Metaizeau JP. Stable elastic intramedullary nailing for fractures of the femur in children. J Bone Joint Surg Br. 2004;86(7):954-7. doi: 10.1302/0301-620x.86b7.15620. [PubMed: 15446516].
11. Carey TP, Galpin RD. Flexible intramedullary nail fixation of pediatric femoral fractures. Clin Orthop Relat Res. 1996;(332):110-8. doi: 10.1097/00003086-199611000-00015. [PubMed: 8913152].
12. Mishra AK, Chalise PK, Shah SB, Adhikari V, Singh RP. Diaphyseal femoral fractures in children treated with titanium elastic nail system. Nepal Med Coll J. 2013;15(2):95-7. [PubMed: 24696924].
13. Lee YH, Lim KB, Gao GX, Mahadev A, Lam KS, Tan SB, et al. Traction and spica casting for closed femoral shaft fractures in children. J Orthop Surg (Hong Kong). 2007;15(1):37-40. doi: 10.1177/230949900701500109. [PubMed: 17429115].
14. Heinrich SD, Drvaric DM, Darr K, MacEwen GD. The operative stabilization of pediatric diaphyseal femur fractures with flexible intramedullary nails: A prospective analysis. J Pediatr Orthop. 1994;14(4):501-7. doi: 10.1097/01241398-199407000-00016. [PubMed: 8077436].
15. Kirby RM, Winquist RA, Hansen ST. Femoral shaft fractures in adolescents: A comparison between traction plus cast treatment and closed intramedullary nailing. J Pediatr Orthop. 1981;1(2):193-7. [PubMed: 7334095].
16. Mann DC, Weddington J, Davenport K. Closed Ender nailing of femoral shaft fractures in adolescents. J Pediatr Orthop. 1986;6(6):651-5. doi: 10.1097/01241398-198611000-00002. [PubMed:
3793884].
17. Nascimento FP, Santili C, Akkari M, Waisberg G, Braga SR, Fucs PM. Flexible intramedullary nails with traction versus plaster cast for treating femoral shaft fractures in children: comparative retrospective study. Sao Paulo Med J. 2013;131(1): 5-12. doi: 10.1590/s1516-31802013000100002. [PubMed: 23538589].
18. Mazda K, Khairouni A, Pennecot GF, Bensahel H. Closed flexible intramedullary nailing of the femoral shaft fractures in children. J Pediatr Orthop B. 1997;6(3):198-202. doi: 10.1097/01202412-199707000-00008. [PubMed: 9260649].
19. Bar-On E, Sagiv S, Porat S. External fixation or flexible intramedullary nailing for femoral shaft fractures in children. A prospective, randomised study. J Bone Joint Surg Br. 1997;79(6): 975-8. doi: 10.1302/0301-620x.79b6.7740. [PubMed: 9393916].
20. Greisberg J, Bliss MJ, Eberson CP, Solga P, d'Amato C. Social and economic benefits of flexible intramedullary nails in the treatment of pediatric femoral shaft fractures. Orthopedics. 2002;25(10):1067-70. doi: 10.3928/0147-7447-20021001-18. [PubMed: 12401013].
21. Verma DP, Chandan RK, Meena RC, Sharma SL. Comparative study of titanium elastic nailing versus hip spica in treatment of femoral shaft fractures in children. IntJ Res Orthop. 2016;2(3):155-8. doi: 10.18203/issn.2455-4510.IntJResOrthop20163122.
22. Shemshaki HR, Mousavi H, Salehi G, Eshaghi MA. Titanium elastic nailing versus hip spica cast in treatment of femoral- shaft fractures in children. J Orthop Traumatol. 2011;12(1):45-8. doi: 10.1007/s10195-011-0128-0. [PubMed: 21340544]. [PubMed Central: PMC3052430].
23. Khaffaf R, Altaweel A. Comparative study between the elastic nail versus hip spica cast in early treatment of pediatric femoral shaft fractures. Open J Orthop. 2016; 6(9):259-67. doi: 10.4236/ojo.2016.69034.
24. Flynn J, Skaggs D, Sponseller P, Ganley T, Kay R, Leitch K. The operative management of pediatric fractures of the lower extremity. J Bone Joint Surg. 2002;84(12):2288-300. doi: 10.2106/00004623-200212000-00025.
25. Czertak DJ, Hennrikus WL. The treatment of pediatric femur fractures with early 90-90 spica casting. J Pediatr Orthop. 1999;19(2):229-32. doi: 10.1097/00004694-199903000-00018. [PubMed: 10088694].
26. Staheli LT. Femoral and tibial growth following femoral shaft fracture in childhood. Clin Orthop Relat Res . 1967;55:159-63. [PubMed: 6079747].
27. Herscovici D, Scott DM, Behrens F, Nelson B, Benton J. The use of Ender nails in femoral shaft fractures: what are the remaining indications? J Orthop Trauma. 1992;6(3):314-7. doi: 10.1097/00005131-199209000-00008. [PubMed: 1403250].
| Files | ||
| Issue | Vol 9 No 3 (2023) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v9i3.13020 | |
| Keywords | ||
| Titanium Nail Cast Pediatrics Femoral Fractures | ||
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How to Cite
1.
Kar S, Ganesh A, Singh A. TENS in Femoral Shaft Fractures of Children. J Orthop Spine Trauma. 2023;9(3):120-4.
