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. 2024 Feb 1:49:102355.
doi: 10.1016/j.jcot.2024.102355. eCollection 2024 Feb.

The use of flexible nails in the treatment of paediatric long bone fractures: Experience at a level one paediatric trauma centre, a cohort study

Alexander Hunt  1 , Nicholas Judkins  1 , Alexandra Biggs  1 , Philip Sedgwick  1   2 , Caroline B Hing  1 , Andrea Yeo  1
Affiliations

The use of flexible nails in the treatment of paediatric long bone fractures: Experience at a level one paediatric trauma centre, a cohort study

Alexander Hunt et al. J Clin Orthop Trauma. .

Erratum in

Abstract

Introduction: Fractures occur in children at an incidence only surpassed by women >85 years and account for 25 % of paediatric injuries. Over the last three decades, there has been a trend towards operative management of children's fractures including utilisation of flexible nails as popularised by the Nancy group in the 1980s. Between 5 and 11 % of paediatric forearm fractures are now fixed in this manner with complication rates of 12-42 %. This study shares the experience of a paediatric level one major trauma centre using this technique in managing long bone fractures in children.

Methods and materials: This retrospective cohort study comprises a sequential series of 109 cases (71 children) of upper and lower limb fractures in children (aged 16 years and below) who underwent fracture fixation using flexible intramedullary nails between 1st April 2015 and 31st March 2019. Radiological and clinical outcomes and complications were assessed.

Results: Ninety-three cases (10 in the lower limb, 83 in the upper limb) satisfied the inclusion criteria in 57 children with a mean age of 8.6 years. All cases were successfully reduced intra-operatively and 92 (98.9 %) achieved union. Taking into account all complications in the upper and lower limb, the overall complication rate is 30.1 % (28 cases) with the vast majority (13 cases, 46.4 %) occurring in the upper limb due to prominence of metalwork prompting early removal.

Conclusions: This study has shown flexible intramedullary nailing to perform well with good stabilisation of a wide variety of paediatric long bone fractures with restoration of bone alignment, satisfactory outcomes with good union rates and a return to normal function. The technique is also safe and in the upper limb can be performed as day-case surgery by a generalist orthopaedic surgeon. Although the overall complication rate is not insignificant, major complications are rare.

Keywords: Fracture; Nail; Paediatric; Trauma.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Study flow diagram showing inclusion and exclusion cases.
Fig. 2
Fig. 2
Preoperative AP and Lateral right forearm radiographs of a 4-year-old boy following a fall off a climbing frame. Both forearm bones are fractured and displaced with an open wound in the volar forearm (Fig. 2, Fig. 3, Fig. 4 are all the same child).
Fig. 3
Fig. 3
AP and Lateral radiographs of right forearm taken 1 week post-operatively following reduction and stabilisation with the T2 Kids Flexible Nailing System. Bone alignment has been successfully restored.
Fig. 4
Fig. 4
AP and Lateral radiographs 5 months post-operatively showing complete radiologic bone union. This child is ready for the metalwork to be removed.
See this image and copyright information in PMC

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