Article

Diaphyseal and metaphyseal fractures in children are
frequently treated with the flexible intramedullary nailing (FIN) method. The aim
of this study was to record postoperative complications and outcome in
consecutive fracture patients treated with the new precurved tip and shaft nails
and dedicated ergonomic instrumentation. METHODS: We report the analysis of 100
consecutive fractures followed up for a minimum of 6 months. Ninety-seven
children were included, comprising 77 shaft and 23 metaphyseal fractures.
Demographic data, duration of surgery, nail and medullary canal diameter, date of
nail removal, clinical assessment, follow-up radiographs and all complications
were recorded. RESULTS: Mean age was 9.7 years, and mean body weight 35.1kg.
Twenty-one fractures had associated lesions. Mean duration of surgery was
42.4minutes. Nail removal was at a mean 6.1 months. Twelve percent of patients
had complications, with six insufficient reductions, one delayed union, one
non-union, one iterative fracture, and three skin impingements. Unexpected
surgical revision was required in seven cases. At follow-up, only one patient
showed functional impairment, with 20 degrees pronation loss, and three showed
more than 10 degrees axial deviation on X-ray. CONCLUSION: The low rate of skin
impingement compared with the literature may be due to the new dedicated
instruments. We believe that other complications can be avoided if one follows
the FIN principles, avoiding weak assembly due to an insufficient nail/medullary
canal diameter ratio, which is a limiting factor for indications in adolescents.
The surgeons reported that precurved shaft nails facilitated the FIN procedure,
although this subjective judgment may be due simply to the novelty of the nails.
LEVEL OF EVIDENCE: Level IV. Retrospective study.
CI - Copyright (c) 2012 Elsevier Masson SAS. All rights reserved.

Langue : FRANCAIS