Treatment of Paediatric Femoral Shaft Fracture with Flexible Intramedullary Nail

Muhammad Noman Parekh, Badaruddin Sahito, Sunil Kumar, Dileep Kumar, Syed Ghulam Mujtaba Shah, Maratib Ali

Abstract

Objective

To find out the functional outcomes after placement of flexible intramedullary nail in paediatric femoral shaft fractures.

Study design

Retrospective study.

Place & Duration of study

Department of Orthopaedics, Civil Hospital Karachi, from July 2017 to June 2019.

Methodology

Children with femoral shaft fracture of both genders were selected. Data was recorded on a pre designed form. All surgeries were done under general anaesthesia with fluoroscopic guidance. Nail diameter was predetermined. After completion of the procedure, stability was assessed radiologically. Postoperatively patients were kept in hospital for 2 days and followed up for at least 3 months along with rehabilitation by Flynn’s criteria. Data analysis was done by SPSS version 21.

Results

There were total of 54 children with 56 femoral shaft fractures. Male patients were 46 (85.2%) and 8 (14.8%) females. The age was between 6 – 16 years with mean age of 8.8 year. There were 52 unilateral femur shaft fractures and 2 patients had bilateral fractures. The commonest injury was road traffic accident (n= 40 - 71.4%), involving right femur most commonly (n= 33 - 58.9%). The middle part of femur was involved in 40 (71.4%) patients. Majority of fractures united at 8- 12 weeks. Flynn’s criteria used for assessment of results, which showed excellent outcome in 47 (84%) children. Five (9.2%) children had limb lengthening, while varus mal-alignment noted in 3 (5.5%), failure of closed reduction in 5 (9.2%) and soft tissue discomfort at entry portal in 8 (14.8%) patients.  Follow-up for one year was uneventful for all children.

Conclusion

Flexible intramedullary nail in paediatric femoral shaft fracture is safe, minimal invasive and cost effective option.

Key words

Femoral shaft fracture, Intramedullary flexible nail, Flynn’s Criteria.