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Failure After Fixation with Failure After Fixation with Flexible IM Nail in Adolescent Flexible IM Nail in Adolescent

Femur Shaft FractureFemur Shaft Fracture

Inje University, Inje University, Ilsan Paik HospitalIlsan Paik HospitalSuk Kyu Choo MDSuk Kyu Choo MD

Pediatric Femur Shaft Pediatric Femur Shaft FractureFracture

►Traction and hip spica castTraction and hip spica cast►Plate and ScrewsPlate and Screws►External FixationExternal Fixation►Flexible IM nailFlexible IM nail

Flexible IM NailFlexible IM Nail

► Elastic titanium nail by Metazear and Lascombes(Nancy NaiElastic titanium nail by Metazear and Lascombes(Nancy Nail)l)

► Easy techniqueEasy technique► Less invasiveLess invasive► Early weight bearing, ROM ex.Early weight bearing, ROM ex.► No physeal injury, or AVN(Interlocking nail), No physeal injury, or AVN(Interlocking nail), ► NO refracture(Plate and screws, Ex-Fix)NO refracture(Plate and screws, Ex-Fix)► Less LLD(?)Less LLD(?)► High union rateHigh union rate

► Bar-On et al, JBJS, 1997Bar-On et al, JBJS, 1997► Oh et al, J Korean Fracture Soc., 2002Oh et al, J Korean Fracture Soc., 2002► Yoon et al, J Korean Fracture Soc., 2003Yoon et al, J Korean Fracture Soc., 2003► Wenger, Rang’s Children’s Fractures, 2005Wenger, Rang’s Children’s Fractures, 2005

Adolescent Femur Shaft Adolescent Femur Shaft FractureFracture

► Interlocking IM nailInterlocking IM nail Trochanteric entry to avoid AVNTrochanteric entry to avoid AVN

► Plate and screwsPlate and screws► Flexible IM nailsFlexible IM nails

Flexible IM NailFlexible IM Nail

► Is it strong enough for heavier adolescents?Is it strong enough for heavier adolescents?►Can it control rotation and angulation in adolCan it control rotation and angulation in adol

escents?escents?

Case 1Case 1

► 14 yrs old girl14 yrs old girl► Femur shaft Femur shaft

fracture with fracture with butterfly fragmentbutterfly fragment

Case 1Case 1

Case 2Case 2

► 16 yrs old girl16 yrs old girl► Lt femur shaft Lt femur shaft

fracture with fracture with butterfly fragmentbutterfly fragment

Case 2Case 2

► CR and IF with CR and IF with Flexible IM nailFlexible IM nail

► LLS and Thigh cuff LLS and Thigh cuff bracebrace

Case 2Case 2

► Thigh cuff braceThigh cuff brace angulationangulation

► Required reop with Ex-Fix.Required reop with Ex-Fix.

Case 3Case 3

► 19 years old girl 19 years old girl with femur shaft with femur shaft fracturefracture

►Narrow femoral Narrow femoral canalcanal

Case 3Case 3► CR and IF with flexible IM nailCR and IF with flexible IM nail► Anterior bowing and nonunion after 8 monthAnterior bowing and nonunion after 8 month► Converted to Interlocking nailConverted to Interlocking nail

Femoral Shaft Fractures in Femoral Shaft Fractures in AdolescentsAdolescents

AuthorsAuthors AgeAge CaseCasess

ComplicationComplicationss

AftercareAftercare

Mann DCMann DC 9-159-15 1515 nonenone crutchescrutches Ender Ender NailNail

Fein LHFein LH 10-1610-16 2323 1 angulation1 angulation crutchescrutches Ender Ender NailNail

Flynn JMFlynn JM 4-164-16 5858 1 varus 1 varus 6 mild malalign6 mild malalignmentment

VariableVariable Titanium Titanium

NailNail

Yoon YHYoon YH 4-114-11 2828 1 fix. Failure1 fix. Failure

1 infection1 infectionBraceBrace TitaniumTitanium

Oh CWOh CW 4-104-10 1919 -- LLS 2 wksLLS 2 wks

Femoral Shaft Fractures in Femoral Shaft Fractures in AdolescentsAdolescents

► Fixation should beFixation should be Stable enough to achieve unionStable enough to achieve union Early motion, early ambulationEarly motion, early ambulation Less complicationsLess complications Easy to applyEasy to apply

Titanium Flexible IM nailTitanium Flexible IM nail

►High union rateHigh union rate►Early motion, ambulationEarly motion, ambulation►No physeal injury vascular injuryNo physeal injury vascular injury►Less invasiveLess invasive►Easy techniqueEasy technique

Titanium Flexible IM nailTitanium Flexible IM nail

►Less stable thanLess stable than Interlocking nailsInterlocking nails Ender Nail(Stainless steel nail)Ender Nail(Stainless steel nail)

►Good result in children’s fractureGood result in children’s fracture►Special considerations in applying to larger aSpecial considerations in applying to larger a

dolescents femur fracturesdolescents femur fractures

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