Abstract
Purpose
The objective of this study was to discuss the risk factors of postoperative limb overgrowth after the application of titanium elastic nailing (TEN) in the treatment of pediatric femoral fractures as well as analyze the causes and provide guidance for clinical treatment.
Methods
The study included children with femoral fractures who were treated with TEN at our hospital from February 2005 to December 2009. Their age, gender, weight, cause of injury, having head trauma or not, fracture site, fracture type and nail-canal diameter (NCD) ratio were recorded. Student’s t-test, chi-square test or Fisher’s exact test was used for univariate analysis of the above factors, and then multivariate logistic regression analysis was used to analyze the possible risk factors in order to determine which ones are associated with limb overgrowth after the application of TEN to treat children with femoral fractures.
Results
Univariate analysis showed that the age, gender, weight, cause of injury, having head trauma or not, and the fracture site did not have a statistically significant association with limb overgrowth (P = 0.741, 0.900, 0.253, 0.739, 0.967 and 0.105, respectively). The fracture type and NCD ratio were significantly associated with limb overgrowth (P = 0.003 and 0.000, respectively). Multivariate logistic regression analysis demonstrated that the fracture type (P = 0.021, OR = 2.757) and NCD ratio (P = 0.002, OR = 2.422) were independent risk factors for limb overgrowth.
Conclusions
The main factors affecting postoperative limb overgrowth are the fracture type and NCD ratio. In order to avoid limb overgrowth, unstable fractures should be fixed as firmly as possible, and the NCD ratio should be ≥0.8.
Similar content being viewed by others
References
Metaizeau JP. L’osteosynthese chez l’enfant par embrochage centromedullaire elastique stable. Montpellier: Sauramps Medical; 1988.
Ligier JN, Metaizeau JP, Prevot J, Lascombes P. Elastic stable intramedullary nailing of femoral shaft fractures in children. J Bone Joint Surg (Br). 1988;70(1):74–7.
Bar-On E, Sagiv S, Porat S. External fixation or flexible intramedullary nailing for femoral shaft fractures in children. A prospective, randomised study. J Bone Joint Surg (Br). 1997;79(6):975–8.
Carey TP, Galpin RD. Flexible intramedullary nail fixation of pediatric femoral fractures. Clin Orthop. 1996;332:110–8.
Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J. Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications. J Pediatr Orthop. 2001;21(1):4–8.
Heinrich SD, Drvaric DM, Darr K, Darr K, MacEwen GD. The operative stabilization of pediatric diaphyseal femur fractures with flexible intramedullary nails: a prospective analysis. J Pediatr Orthop. 1994;14(4):501–7.
Beaty JH, Kasser JR. Rockwood and Wilkins fractures in children. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 487–532.
Houshian S, Gothgen CB, Pedersen NW, Harving S. Femoral shaft fractures in children: elastic stable intramedullary nailing in 31 cases. Acta Orthop Scand. 2004;75(3):249–51.
Flynn JM, Luedtke L, Ganley TJ, Pill SG. Titanium elastic nails for pediatric femur fractures: lessons from the learning curve. Am J Orthop. 2002;31(2):71–4.
Carey RP, de Campo JF, Menelaus MB. Measurement of leg length by computerised tomographic scanography: brief report. J Bone Joint Surg (Br). 1987;69(5):846–7.
Schlickewei W, Salm R. Indications for intramedullary stabilization of shaft fractures in childhood. What is reliable, what is assumption?. Kongressbd Dtsch Ges Chir Kongr. 2001;118:431–4.
Luhmann SJ, Schootman M, Schoenecker PL, Dobbs MB, Gordon JE. Complications of titanium elastic nails for pediatric femoral shaft fractures. J Pediatr Orthop. 2003;23(4):443–7.
Flynn JM, Luedtke LM, Ganley TJ, Dawson J, Davidson RS, Dormans JP, Ecker ML, Gregg JR, Horn BD, Drummond DS. Comparison of titanium elastic nails with traction and a spica cast to treat femoral fractures in children. J Bone Joint Surg (Am). 2004;86-A(4):770–7.
Gogi N, Khan SA, Varshney MK. Limb length discrepancy following titanium elastic nailing in paediatric femoral shaft fractures. Acta Orthop Belg. 2006;72(2):154–8.
Reynolds DA. Growth changes in fractured long-bones: a study of 126 children. J Bone Joint Surg (Br). 1981;63-B(1):83–8.
Moroz LA, Launay F, Kocher, Newton PO, Frick SL, Sponseller PD, Flynn JM. Titanium elastic nailing of fractures of the femur in children. Predictors of complications and poor outcome. J Bone Joint Surg (Br). 2006;88(10):1361–6.
Clement DA, Colton CL. Overgrowth of the femur after fracture in childhood. An increased effect in boys. J Bone Joint Surg (Br). 1986;68(4):534–6.
Shapiro F. Fractures of the femoral shaft in children. The overgrowth phenomenon. Acta Orthop Scand. 1981;52(6):649–55.
Fakoor M, Mousavi S, Javherizadeh H. Different types of femoral shaft fracture; different types of treatment: their effects on postoperative lower limb discrepancy. Pol Przegl Chir. 2011;83(9):477–81.
Park SS, Noh H, Kam M. Risk factors for overgrowth after flexible intramedullary nailing for fractures of the femoral shaft in children. Bone Joint J. 2013;95-B(2):254–8.
Mahar A, Sink E, Faro F, Oka R, Newton PO. Differences in biomechanical stability of femur fracture fixation when using titanium nails of increasing diameter. J Child Orthop. 2007;1(3):211–5.
Sink EL, Gralla J, Repine M. Complications of pediatric femur fractures treated with titanium elastic nails: a comparison of fracture types. J Pediatr Orthop. 2005;25(5):577–80.
Conflict of interest
None
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Dai, CQ., Yang, J., Guo, XS. et al. Risk factors for limb overgrowth after the application of titanium elastic nailing in the treatment of pediatric femoral fracture. J Orthop Sci 20, 844–848 (2015). https://doi.org/10.1007/s00776-015-0739-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00776-015-0739-z