Outcome of Diaphyseal Femur Fractures Treated with Enders Nail in Paediatric Age Group

Abstract

INTRODUCTION: In children, shaft femur fracture is the most common injury sustained.Earlier these
fractures were treating conservatively but with advancement of orthopaedic implants and surgical modalities
now operative intervention is favourable for early mobilization with less complication. Inadequate
reduction/fixation can lead to growth disturbances among children about to attain skeletal maturity closure.
Variety of surgical options includes external fixators, plates and flexible intramedullary nailsand has its own
complications, but the choice of implant to be used as gold standard in the management of these fractures is still
a matter of debate.Enders nailing among the Flexible Intramedullary Nails, being a minimal invasive procedure
and tensile property of the nail along with the feasibility of early mobilizationled to its popularity.
AIM: Aim of the study was to evaluate the use of Endersnail in paediatric diaphyseal femur fractures in terms
of union, complications, early mobility and minimally invasive technique.
MATERIALS AND METHODS: Thisinterventional prospective study was conducted from May 2017- April
2019 with 32 paediatric patients with diaphyseal femur fracture in a 5-15 years age group.Retrograde enders
nailingwasdone in all diaphyseal femur fractures using traction table.Enders nail were inserted using either of
the two configurations, one is two medial C and S constructs and another double or divergent C.All patients
were followed up periodically for minimum 1 year and assessed using FLYNN SCORING SYSTEMand
evaluated for clinical, functional and radiological outcomes. We also developed a protocol for implant removal
in all our patients after 6 months of fracture union. RESULTS:In our study, age group of 10-12 years was the most common with Mean age of 11.6 yearswith male
predominance. Male to Female ratio was 4:1. Mean radiological union was8.8±1.68 weeks. Final result
according to Flynn scoring system was excellent in 90.6%.Among the complications, 3 cases of knee stiffness
due to immobilization which become normal after vigorous physiotherapy and 5 had nail impingement which
got cured after nail removal.
CONCLUSION:According to our study use of Ender’s nail for pediatric shaft femur fracture has advantage of
minimally invasive procedure, early mobilization, short hospital stay, cost effectivenesswith minimal
complications.