Results of quadruple elastic nailing for length unstable fracture femur in pediatrics

Abstract

Background Length-unstable shaft femur fractures including spiral, long oblique, and comminuted fractures are mechanically unstable under axial, bending, and rotational forces. The risk of shortening, rotation, and malalignment increases substantially with the standard technique using only two nails. Our study was the first to report the results of quadruple elastic nailing for length-unstable femoral fractures on a prospective basis. Moreover, our study was the first to correlate this technique to the operative time and to the radiation exposure time. Patients and methods In all, 26 patients with simple length-unstable pediatric shaft fracture femur were included from October 2020 to October 2022. We used four elastic stable intramedullary nails (ESINs) for fracture fixation. Operative time and radiation exposure time were calculated for each patient. Follow-up of union was judged by radiograph at 1, 2, 3, and 6 months postoperatively. The Flynn score was used for evaluation at the 6th month postoperatively. Results Most of the studied cases were associated with excellent outcomes (84.6%) with four cases being associated with satisfactory outcomes (15.4%). Entire cases were associated with full ROM with no recorded angular deformity or rotational deformity. The mean operative time, radiation exposure time, and full union duration were 1.23 ± 0.31 h, 1.26 ± 0.27 min, and 9.08 ± 2.78 weeks, respectively. Conclusion Our case series supports the use of ESIN in length-unstable diaphyseal femur fractures with 26 patients treated with a quartet of ESINs.