Comparison of rush pins with titanium elastic nails for treatment of pediatric femoral shaft fractures

Abstract

Background: Pediatric femoral shaft fracture accounts for 1-2% of all pediatric fractures. Closed reduction and internal fixation with intramedullary devices is the treatment of choice for children older than 4 years. However, antegrade intramedullary devices are associated with concerns regarding possibility of injury to the vascular supply of the proximal femur. Therefore, retrograde titanium elastic nails (TENs) have become increasingly popular in recent years. Purpose: The purpose of this study was to compare the clinical outcomes of children with femoral shaft fractures treated with antegrade Rush pin and retrograde TENs. Methods: After obtaining the approval of the review board, we retrospectively reviewed the charts of 61 children who presented with femoral shaft fractures between 1991 and 2010. Thirty-eight boys and 23 girls (mean age: 8.8 years) were studied. Thirty-two children were treated with a Rush pin and the other 29 children with TENs. The radiographic and clinical outcomes were compared between the two groups. Results: The coronal alignment of the femur was not significantly different between the two groups (2.46° vs. 1.07°, p = 0.16). However, the sagittal bowing is significantly greater in children treated with TENs (1.2° vs. 7.7°, p ＜ 0.001). Leg length discrepancy is 2.4mm and 2.7mm longer than the uninjured side in Rush pin and TENs group respectively (p = 0.85). No femoral head osteonecrosis or proximal femoral deformity was revealed on the final radiographs. The clinical outcomes were comparable between the two groups. Conclusion: The outcomes in the children treated with a Rush pin inserted through the tip of the greater trochanter were not inferior to those treated with TENs. Therefore, the Rush pin may continue to be an alternative device if the TENs are not affordable or not available in medical facilities.

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