Review Question - QID 3529

Bridge plating is the best option for a 10 year old with contraindications to flexible nailing (Illustration A). Titanium flexible nails should be avoided in patients with length unstable fractures and in those with > 11 years of age and > 108 lbs. As the patient is 10 years old and has open physes, there are concerns with intramedullary nailing (greater troch or piriformis entry). Decision making varies among surgeons as to the appropriate age for far-lateral entry nailing.

Kocher et al reviewed pediatric diaphyseal femur fractures in the AAOS clinical practice guidelines. Current treatment recommendations are based on patient age, fracture characteristics, and family social situation. Evidence for treatment of fractures of children of various ages were graded as grade A (recommend), B (suggest), C (option) or unable to recommend for or against.

Wall et al investigated titanium versus stainless steel retrograde elastic nails in 104 pediatric patients. Malunion rates were approximately four times higher in the titanium group. In addition, the cost of titanium nails was over 3 times higher than stainless steel nails.

Incorrect answers:
1. A 4-year-old boy would best be treated in a spica cast.
2. A patient under 11 and under 110lbs with a length-stable fracture could be best treated with flexible nails or possiblly bridge plating.
4. A skeletally mature patient would be best treated with an IM nail.
5. A skeletally mature patient would be best treated with an IM nail.