An alternative choice for overweight pediatric patient with femoral shaft fracture when rigid nail is contraindicated due to narrow intramedullary canal: Elastic stable intramedullary nail plus temporary external fixator

Xin Tang; Jiaxin Liang; Baowen Zhang; Saroj Rai; Qingyi Hu; Yan Zou; Pan Hong

doi:10.1016/j.jos.2025.01.002

An alternative choice for overweight pediatric patient with femoral shaft fracture when rigid nail is contraindicated due to narrow intramedullary canal: Elastic stable intramedullary nail plus temporary external fixator

J Orthop Sci. 2025 Jan 16:S0949-2658(25)00034-X. doi: 10.1016/j.jos.2025.01.002. Online ahead of print.

Authors

Xin Tang¹, Jiaxin Liang², Baowen Zhang³, Saroj Rai⁴, Qingyi Hu¹, Yan Zou⁵, Pan Hong⁶

Affiliations

¹ Department of Orthopaedic Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Department of Geriatrics, The First Hospital of Jilin University, Changchun, China.
³ First Clinical School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁴ Department of Orthopaedics, Al Ahalia Hospital Mussafah, Abu Dhabi, United Arab Emirates.
⁵ Otorhinolaryngology Head and Neck Surgery, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China.
⁶ Department of Orthopaedic Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: [email protected].

PMID: 39824700
DOI: 10.1016/j.jos.2025.01.002

Abstract

Background: Length unstable femoral shaft fractures in school-aged children usually demand surgical treatment, but the optimal choice remains controversial, especially in overweight adolescents. This study aimed to compare the clinical results of locking compression plates (LCP) and elastic stable intramedullary nails (ESIN) combined with temporary external fixator (TEF) in school-aged children weighing over 50 kg.

Methods: Between January 2010 and January 2018, children over 50 kg with length unstable femoral shaft fracture treated with ESIN & EF in the authors' institute were included in this study. Adolescent patients with matched age, sex, body weight and fracture type receiving LCP were retrieved from hospital database. The Flynn Score System was used to evaluate the clinical outcomes of treatments at the last follow-up.

Results: A total of 30 young children aged 10-14 years were included. Fifteen patients (9 male and 6 female) received ESIN & EF treatment, while the other fifteen (9 male and 6 female) received LCP treatment. All patients were followed up for more than 12 months post-surgery (14-26 months). In all, less operation time, less estimated blood loss and shortened hospital stay (P < 0.001), faster union time (P = 0.031) were observed in ESIN & EF group, compared with the Plating group. All surgeries in the ESIN & EF group were performed without exposing the fracture site. In contrast, 60 % (9/15) of the surgeries in the Plating group were performed with the fracture site exposed. Every patient scored satisfactory or excellent on the Flynn Score System without major complications demanding revision surgeries.

Conclusions: ESIN plus EF produces satisfactory clinical outcome for overweight pediatric patients with femoral shaft fracture when rigid nail is contraindicated due to narrow medullary canal.

Keywords: Elastic stable intramedullary nail; External fixator; Length unstable; Pediatric femoral shaft fracture; Plating.