Ender Nail Applications in Femoral Diaphysis Fractures

Abstract

Aim: Although the femoral shaft fractures are treated conservatively for up to 6 years in children, surgical treatment should be considered in patients with femoral shaft fractures in school age or in those who have multiple long-bone fracture or organ injury. But it is a controversial issue which surgical treatment is ideal. Material and Method: Twenty-nine femoral fractures of 26 patients whose surgical treatment of femoral shaft fractures were made with Ender nails were prospectively evaluated. Under general anesthesia, 4,5 mm of 2 Ender nails were performed from the metaphysis to all of the patients. The patients were evaluated according to the type of the fracture, duration of the union, the discrepancy of shortening-length, the rotation, limitation of the joint movement, the complications such as refractures and the criterions of Flynn in terms of the clinical outcomes. Results: The mean age of the patients was 9.2 years (4-14). The type of the fracture was Winquist Hansen type 2 and 3. The mean duration of the follow-up was 18 months (13-38). While the etiology of the fractures was the traffic accidents in twenty of the patients, gunshot wounds and falling from height were in the others. The mean duration of the union was 6.5 (5-8) weeks in all patients. The discrepancy of shortening-length was an average of 6 mm (2-20), the difference of the rotation was an average of 3 degree (2-7), and the angulation of varus-valgus was an average of 4 degrees (2-9) in the femurs which were treated in the patients. The limitation of the movement in the knee joint was of an average 5 degrees (3-10) as the flexion and extension. None of the patients developed refractures. Excellent result in 20 fractures, good result in 7 fractures and bad result in 2 fractures were observed according to the criterions of Flynn. Discussion: Ender nail should be considered first for the possibility of early return to school, the low risk of refracture and the price advantage in the surgical treatment of femoral shaft fractures in children aged 5 and above.