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synonyms:Pediatric Femoral Shaft Fracture Flexible Nail, femural shaft intramedullary nail, IM nail
Pediatric Femoral Shaft Fracture Flexible Nail CPT
Pediatric Femoral Shaft Fracture Flexible Nail Anatomy
Pediatric Femoral Shaft Fracture Flexible Nail Indications
- Pediatric femoral shaft fracture in patient 6months - 5years with greater than 2cm of shortening
- Pediatric femoral shaft fracture in patient 7-11yrs
- Multitrauma
Pediatric Femoral Shaft Fracture Flexible Nail Contraindications
- Infants(1-6 months)= pavlic harness +/- supplemental splint
- 11-16yrs= trasntrochateric nail, consider external fixation, ORIF
Pediatric Femoral Shaft Fracture Flexible Nail Alternatives
- ORIF
- Spica casting
- External Fixation
Pediatric Femoral Shaft Fracture Flexible Nail Planning / Special Considerations
- Risks=femoral vessels, femoral nerve, sciatic nerve and its divisions, hip&knee joint
- Deep femoral vessels and saphenous nerve are most vulnerable as they pass through Hunter’s canal which can extend from the mid-aspect of the femur to the distal 1/6th.
- Knee joint(suprapatellar pouch) extends anterior @6.3cm above the proximal pole of the patella
Pediatric Femoral Shaft Fracture Flexible Nail Technique
- Sign operative site.
- Pre-operative antibiotics, +/- regional block.
- General endotracheal anesthesia
- Supine position on radiolucent table. All bony prominences well padded.
- Prep and drape in standard sterile fashion.
- Open Fractures: debrided skin edges sharply, debride all non-viable tissue,, irrigated with at least 9L of fluid.
- Medial and lateral incisions for entry point into bone just proximal to physis.
- Pre-bend nails to allow passage.
- Nail options include Synthes flexible nails(titanium, cut to size after insertion) and Enders(stainless steel, have eye for easy removal, cheaper, must measure length before insertion) nails. Both come in sizes from 2.5-4.5mm with multiple lengths.
- Goal=80% canal fit.
- Irrigate.
- Close in layers.
Pediatric Femoral Shaft Fracture Flexible Nail Complications
- Leg Length Discrepancy 736.81: overgrowth common in ages 2-10y/o.
- Infection
- Delayed union
- Nonunion
- Vascular injury
- Compartment syndrome
- tibial physeal closure and development of genu recurvatum deformity (Bowler, J Pediatric Orthop 10:653;1990)
- Painful hardware (pain at flexible nail insertion site)
Pediatric Femoral Shaft Fracture Flexible Nail Follow-up care
- Post-op:generally non-weight bearing
- 7-10 Days:
- 6 Weeks:
- 3 Months:
- 6 Months:
- 1Yr:
Pediatric Femoral Shaft Fracture Flexible Nail Outcomes
- Complication rate = 17%; higher for patients >10years old. (HO CA, JPO 2006;26:497)
- Average time to full weight bearing = 10 weeks
- Time to radiographic union averages 10.7 weeks
- Time to return to preoperative level of activity averages 4.9 months.
- Average loss of hip flexion is 0 degrees at 3 months and an average loss of knee flexion of 4 degrees at 6 months.
- Limb length discrepancy greater than 1 cm occurs in 8% which decreases to 2% by 2 years.
Pediatric Femoral Shaft Fracture Flexible Nail Review References
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