Use of elastic nailing for the treatment of paediatric long bone fractures in community hospital settings

Abstract

Background:  Long bone fractures in the paediatric population are treated with elastic intramedullary nailing. Nailing techniques and hardware have evolved significantly since its initial introduction in the early 1980s and they are considered a reliable method in treating these fractures. In Greece, the surgical management of these fractures is usually performed by specialist surgeons in tertiary paediatric hospitals.

Technique: With this retrospective study we investigate the operative management of paediatric and adolescent long bone fractures treated by general Orthopaedic surgeons in a community hospital. Our aim is to assess whether elastic intramedullary nailing is a reliable and appropriate treatment in community hospital settings.

Patients and methods: We retrospectively reviewed 58 patients with a total of 75 fractures   that have been managed operatively in our hospital from February 2006 until February 2015. There were 6 femoral, 7 tibial, 27 radial shaft, 4 radial head, 23 ulna and 8 humeral fractures. The mean age was 10.6 years (range 4 -17 years) and the male to female ratio 4:1.

Results and Conclusion: All fractures where anatomically reduced, there were four cases of skin irritation at nail insertion and two delayed unions in femoral fractures that resolved without compromise. The range of motion returned to levels equal to the uninjured side. There was one case of leg length discrepancy due to a femoral fracture that was subsequently managed with a distal femoral epiphysiodesis. Our series had no significant deviations from the bibliographic average in terms of functional and aesthetic result, complications and bed stay compared to major health centers in Greece and abroad.