Elastic intramedullary nail in the repair of long bone fractures in children: rigid fixation and jiggling at the fracture site promote fracture healing

doi:10.3969/j.issn.2095-4344.2014.48.021

Abstract

Abstract:

BACKGROUND: Elastic intramedullary nail for children with specific elastic with bend round metal strip structure, is based on adult long bone fracture treatment using intramedullary needle through the development, evolution and improvement, and has become the minimally invasive treatment method in children with fractures. As a intramedullary fixation device, it has sufficient fixing strength for children long bone fractures, simultaneously can promote jiggling at the fracture site, finally contribute to fracture healing. At present, it has been a novel fixation material for treatment of children long bone fractures.
OBJECTIVE: To retrospectively summarize and evaluate the clinical outcomes of elastic intramedullary nail internal fixation for the treatment of children with long bone shaft fracture using minimally invasive surgery.
METHODS: From January 2010 to April 2014, 30 children with long bone shaft fractures were treated with elastic intramedullary nail fixation, including 4 cases of femur, 11 cases of tibia and fibula fractures, 4 cases of humerus, 7 cases of ulnar and radial fractures, 3 cases of ulnar fractures, and 1 case of radial fracture. All cases were fresh closed fracture. There were 21 males and 9 females. Their age at injury was from 5 to 16 years old, averagely 9.6 years. 23 cases received closed reduction, and 7 cases received limited small incision reset due to difficult closed reduction. Fracture reduction, operation time, healing time, functional recovery after fixation, curative effects of Flynn intramedullary nail, post-fixation complications and adverse events were observed in children.
RESULTS AND CONCLUSION: Operation time was between 25 and 65 minutes in 30 children, averagely 51 minutes. All fracture sites were reduced. All patients were followed up for 6-12 months. All fractures were healed, and the healing time ranged from 8 to 16 weeks, averagely 12 weeks. The excellent and good rate of Flynn intramedullary nail was 100%. The function of affected limbs recovered to normal. No complication occurred. The technology has the advantages of small incision, no need to strip periosteum, minor soft tissue injury, short operation time, low infection rate, biomechanical stability, quick functional recovery, fast healing, and less complications. Its design focuses on children fracture characteristics and growth rule of bone tissue, and is very suitable for long bone fracture fixation.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: fractures, bone, internal fixators, surgical procedures, minimally invasive, follow-up studies

CLC Number:

R318

Wang Yao-wei, Wu Shu-hua, Wang Shu-jin, Li Yun-long, Zhu Dong-bo. Elastic intramedullary nail in the repair of long bone fractures in children: rigid fixation and jiggling at the fracture site promote fracture healing[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(48): 7827-7832.

Figures/Tables 4

References

[1] Ligier JN, Metaizeau JP, Prévot J,et al. Elastic stable intramedullary nailing of femoral shaft fractures in children. J Bone Joint Surg Br. 1988;70(1):74-77.
[2] Fernandez FF, Eberhardt O, Wirth T. Elastic stable intramedullary nailing as alternative therapy for the management of paediatric humeral shaft fractures.Z Orthop Unfall. 2010;148 (1):49-53.
[3] Weinberg AM, Castellani C, Amerstorfer F. Elastic Stable Intramedullary Nailing (ESIN) of forearm fractures. Oper Orthop Traumatol. 2008;(4-5):285-296.
[4] Maier M, Marzi I. Elastic stable intramedullary nailing of femur fractures in children. Oper Orthop Traumatol. 2008; (4-5): 364-372.
[5] 吴素英.髓内钉置入治疗儿童股骨干骨折:来源于SCI数据库的文献分析[J].中国组织工程研究, 2012,16(30):5670-5567.
[6] 王华明,陈志龙,李卫平,等.弹性髓内钉治疗儿童股骨干骨折钢板固定失效病例[J].中国组织工程研究, 2013,17(26): 4819-4825.
[7] Flynn JM, Hresko T, Reynolds RA, et al. Tianium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications. J Pediatr Orthop. 2001; 21(1):4-8
[8] 陈博昌,王志刚,杨杰,等.弹性髓内针交叉固定治疗儿童长骨骨折[J].中国矫形外科杂志,2003,11(9):598-601.
[9] Aktu?lu K, Ozkayin N. Long-term results of elastic intramedullary nailing in pediatric femoral shaft fractures. Ulus Travma Acil Cerrahi Derg. 2003;9(3):203-208.
[10] 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.
[11] Furlan D, Pogoreli? Z, Biotic M, et al. Elastic stable intramedullary nailing for pediatric long bone fractures: experience with 175 fractures. Scand J Surg. 2011;100(3): 208-215.
[12] Lu B, Liu P, Wang Y. Application of elastic intramedullary nail in the treatment of both ulna and radius fractures in children. Zhong Hua Yi Xue Za Zhi.2014;94(24):1882-1885.
[13] 刘国庆,王文己,时红萍,等.弹性髓内钉与钢板内固定修复前臂骨折疗效与安全性的Meta分析[J].中国组织工程研究, 2014, 18(26): 4248-4253.
[14] Lefèvre Y,Journeau P, Angelliaume A, et al. Proximal humerus fractures in children and adolescents. Orthop Traumatol Surg Res. 2014;100 (1 Suppl):S149-156.
[15] Antabak A, Luetic T, Ivo S, et al. Treatment outcomes of both-bone diaphyseal paediatric forearm fractures. Injury. 2013;44 (Suppl 3) S11-15.
[16] Kaiser MM, Zachert G, Wendlandt R, et al. Increasing stability by pre-bending the nails in elastic stable intramedullary nailing: a biomechanical analysis of a synthetic femoral spiral fracture model. J Bone Joint Surg Br. 2012;94(5):713-718.
[17] Doser A,Helwig P, Konstantinidis L, et al. Does the extent of prebending affect the stability of femoral shaft fractures stabilized by titanium elastic nails? A biomechanical investigation on an adolescent femur model.J Pediatr Orthop. 2011;31 (8):834-838.
[18] Richter D, Ostermann PA, Ekkernkamp A, et al. Elastic intramedullary nailing: a minimally invasive concept in the treatment of unstable forearm fractures in children. J Pediatr Orthop. 1998;18(4):457-461.
[19] Perez A, Mahar A, Negus C, et al. A computational evaluation of the effect of intramedullary nail material properties on the stabilization of simulated femoral shaft fractures. Med Eng Phys. 2008;30(6):755-760.
[20] Sinikumpu JJ, Keränen J, Haltia AM, et al. A new mini-invasive technique in treating pediatric diaphyseal forearm fractures by bioabsorbable elastic stable intramedullary nailing: a preliminary technical report. Scand J Surg. 2013;102(4):258-264.