| BackgroundThe femoral shaft fracture is one of the most common fractures in children. The orthodox therapy include fixation by plaster, traction, operation and so on. Because there were multiform forte and demerit in every therapy, and a lot of limiting facts, the orthopedist keep finding more and more eligible therapy to solve it. Using closed reduction and titanium elastic nailing(TEN) for the femoral shaft fracture in children belongs to minimum invasive surgery. It was a new method of the treatment to over 5 years old children's limbs shaft fracture recently. The operating principal to achieve the elastic fixation by three point contact, and it was fit to cure the transversal and short spiral fractures. To study of operation and curative effects of surgical treatment of the femoral shaft fracture in children with titanium elastic nail was worthy to do.ObjectiveTo study the indication, operation technique, clinical curative effect and complication of the treatment of pediatric femoral shaft fractures by TEN, and to provide a suit of methods to cure these fractures. MethodsA retrospective investigation was conducted on 78 children who had been treated with TEN from October 2005 to August 2007 in our hospital, including 46 cases of male and 32 cases of female; 42 cases of right femoral shaft fracture, 36 cases of left; the mean age of all patients was 7.8yr (range 1yr and 7mon~13yr). The average time from injury to operation is 1.3 days (range 50min~10ds). And according to different of the age, classification of fracture and site of the fracture, 12 cases of femoral shaft fractures fixed with single TEN, 66 cases with double TEN, and retrograde insertion 32 cases, antegrade insertion 35 cases, combination of retrograde and antegrade 11 cases.ResultsAll of the 78 cases were followed up, and the mean follow-up was 19 months. According to the Flynn's score standard (2001), the excellent result ( leg length inequality﹤1.0cm, malalignment﹤5°, no pain, no complication ) were found in 65 cases, satisfactory result (leg length inequality﹤2.0cm, malalignment﹤10°, no pain, no complication ) in 8 cases, and poor (leg length inequality﹥2.0cm, malalignment﹥10°, pain present, major complication and/or lasting mobility) in 5 cases. The excellent and good rates was 93.6﹪.2 cases belong to affected extremity be short>2.0cm, following up 1.5 year , leg length inequality<1.0cm. The other 3 cases were knee joint motion be limited about 30°~50°, and 2 cases recovered by exercise in 1 year, 1 case was still poor. The excellent and good rates was 98.7﹪. No broken and ununited cases in this team.ConclusionsUsing titanium elastic nailing has obvious advantage including safety, convenient and volant therapy method for pediatric long bones fracture. It was fit to treat almost all femoral shaft fractures in children, especially for lateropulsition,short oblique femoral shaft fractures. Compared to the orthodox technique as epithesis or gypsum fixation or open reduction, this technique has many forte, such as small skin wound, tiny tissue damage, no damage for the epiphyseal plat, no influence blood circulation in marrow, fractures recovery fast, short period in hospital, the nails pull out convenience and child easy tolerance. In a word,it is an effective therapeutic approach for pediatric femoral shaft fractures, and worthy to be spread.
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