Flexible intramedullary nailing of the children

BACKGROUND: Various methods are being used in the treatment of femur diaphysial fractures in children aged between 6 to 12 years. Titanium elastic nailing is one of the alternatives. We evaluated our experience in flexible intramedullary nailing.
METHODS: We investigated 21 patients with femur diaphysial fractures who were with titanium elastic nailing. RESULTS: The mean age of the patients was 9.6±2.4 (range between 5.1-14.7 years) and all the fractures were at the diaphyisis. The fracture pattern was as following: 9 (42.9%) transverse, 7 (33.3%) oblique, 5 (23.8%) spiral. Fixations were performed with two nails which were implanted in retrograde manner. The average time of follow-up was 29±11.6 months (range; 9-48 month). The mean time to fracture union was 13±11.9 weeks (4-52). Implant removal was performed after a mean time of 7±2.2 months (range; 6-16 month). Patients’s hip and knee range of motions were complete and clinically there were no angular or rotational deformity at postoperative one year. There were radiologically 11±1.7 (range; 10-15) degrees of varus valgus malalignment in 8 patients; these angles were reduced to 5±1.9 (range; 3-9) degrees at the follow of two years. CONCLUSION: The results of the flexible titanium nailing in femur diaphysial fractures of the children, aged between 6 to 12 years, suggest that this method may be a first choice therapy in this particular group of patients.

Çocuk femur cisim kýrýklarýnda esneyebilen intramedüller çivi uygulamasý

AMAÇ: 6-12 yaþ arasý çocuklarda femur cisim kýrýklarýnýn tedavisinde farklý tedavi yöntemleri uygulanmaktadýr. Titanyum elastik çivi de bunlardan biridir ve çalýþmamýzda kliniðimizin bu uygulamayla ilgili sonuçlarý araþtýrýldý.
GEREÇ-YÖNTEM: Kliniðimizde retrograd titanyum elastik çiviyle tespit uygulanan femur cisim kýrýklý 21 hasta incelendi. BULGULAR: Hastalar 5,1-14,7 yaþlarýnda ortalama 9,6±2,4 yaþta ve bütün kýrýklar femur diyafizinde idi. Kýrýklarýn dokuzu (%42,9) transvers, yedisi (%33,3) oblik, beþi de (%23,8) spiraldi. Kýrýk redüksiyonu 9 hastada (%42,9) kapalý, 12 hastada (%57,1) lateralden mini insizyonla açýk olarak yapýldý. Çivilerin biri medial diðeri ise lateralden olmak üzere iki adet ve retrograd yöntemle gönderildi. Ameliyat sonrasý dönemde 8 hastaya (%38) alçý atel uygulandý. Hastalarýn ortalama takip süresi 29±11,6 ay (9-48) olarak gerçekleþti. Ortalama 13±11,9 haftada (4-52) tam kaynama saptandý. Ortalama 7±2,2 ayda (6-16) implantlar çýkarýldý. Ameliyat sonrasý birinci yýlda tüm hastalarýn kalça ve diz hareket geniþlikleri tamdý ve klinik olarak rotasyonel veya açýsal deformite saptanmadý. Radyolojik olarak 8 hastada ortalama 11±1,7 (10-15) derecelik varus-valgus deformitesi görülmesine raðmen iki yýllýk takip sonucunda bu açý ortalama 5±1,9 (3-9) dereceye düþtü. SONUÇ: 6-12 yaþ arasý çocuklardaki femur cisim kýrýklarýnýn tedavisinde titanyum elastik çiviyle tespitin sonuçlarý, bu grup hastalarýn tedavisinde ilgili yöntemin ilk tercih olabileceðini düþündürmektedir.