Salonen A, Lahdes-Vasama T, Mattila V M, Välipakka J, Pajulo O
Department of Pediatric and Adolescent Surgery, Pediatric Clinics and Pediatric Research Center, Tampere University Hospital, Tampere, Finland
Department of Pediatric and Adolescent Surgery, Pediatric Clinics and Pediatric Research Center, Tampere University Hospital, Tampere, Finland.
Scand J Surg. 2015 Jun;104(2):121-6. doi: 10.1177/1457496914529275. Epub 2014 Apr 15.
Despite several potential complications of elastic intramedullary nailing, it is currently the treatment of choice for femoral diaphyseal fractures in school-aged children. This study aimed to critically evaluate the complications of titanium elastic nailing in pediatric femoral shaft fractures.
This study evaluated patients with a diaphyseal femoral fracture treated with titanium elastic nailing (TEN) in Tampere University Hospital in Finland. The study group included 32 children with a mean age of 9 years during a 5-year period, from 1 January 2003 to 31 December 2007. Data were collected from medical records and x-rays. Mean follow-up time was 42 months.
Of 32 patients, 9 (28%) reported a postoperative complication. Complications were associated with nail prominence in five (16%) patients and instability in four (12%) patients. In patients with nail prominence, the titanium elastic nailing-nail ends were unbent and 10-35 mm outside the cortex of the distal femur. The nail prominence caused pain and delayed knee mobilization until the nail was removed after a mean time of 4 months. In patients with fracture instability, the mean titanium elastic nailing-nail/medullary canal diameter ratio was 46% and periosteal callus formation was 5.4 mm at the first control. In those with stable fractures, the values were 66% and 9.2 mm, respectively.
Based on this study, two types of pitfalls in a small volume center were found. Titanium elastic nail ends were left unbent and too long. We recommend palpating the nail ends to exclude nail prominence and to verify free movement of the knee after nail cutting and bending. Fracture instability was caused by inserting titanium elastic nailing-nails that were too narrow. To avoid this complication, careful preoperative planning to select the proper-size titanium elastic nailing-nails and intraoperative testing of fracture stability under continuous fluoroscopy after the operation is advised.
尽管弹性髓内钉存在一些潜在并发症，但它目前仍是学龄期儿童股骨干骨折的首选治疗方法。本研究旨在严格评估钛弹性髓内钉治疗小儿股骨干骨折的并发症。
本研究评估了芬兰坦佩雷大学医院采用钛弹性髓内钉（TEN）治疗的股骨干骨折患者。研究组包括2003年1月1日至2007年12月31日这5年间的32名儿童，平均年龄为9岁。数据收集自病历和X线片。平均随访时间为42个月。
32例患者中，9例（28%）报告有术后并发症。并发症与5例（16%）患者的钉突出及4例（12%）患者的骨折不稳定有关。在钉突出的患者中，钛弹性髓内钉钉端未弯曲，位于股骨远端皮质外10 - 35毫米处。钉突出导致疼痛并延迟膝关节活动，直至平均4个月后取出钉子。在骨折不稳定的患者中，首次复查时钛弹性髓内钉与髓腔直径的平均比值为46%，骨膜骨痂形成量为5.4毫米。在骨折稳定的患者中，相应的值分别为66%和9.2毫米。
基于本研究，在一个小容量中心发现了两种陷阱。钛弹性髓内钉钉端未弯曲且过长。我们建议触摸钉端以排除钉突出，并在剪钉和弯钉后检查膝关节的自由活动情况。骨折不稳定是由插入过窄的钛弹性髓内钉引起的。为避免这种并发症，建议术前仔细规划以选择合适尺寸的钛弹性髓内钉，并在术后连续透视下进行骨折稳定性的术中测试。
