PMU-Autor/inn/envon Rüden Christian
Surgical therapy is the treatment of choice in the treatment of femoral shaft fractures in children and adolescents due to an increased need for mobility. Since elastic stable intramedullary nailing (ESIN) was introduced in the 1980s it has become the gold standard fixation technique for these fractures. Nevertheless, with broadening indications, more complications have been described due to this technique. Recent studies reported biomechanical limitations especially in older and in heavier children. In this group of patients but also all fracture types in which ESIN does not guarantee secure stabilization, alternative surgical techniques are recommended. Indications for the usage of external fixators for rapid fixation are polytrauma and poor soft tissue conditions. Plate fixation represents a good alternative to internal fixation of proximal or distal femoral fractures. As it is not necessary to achieve anatomic reduction, minimally invasive plate osteosynthesis (MIPO) is preferred. Conventional anterograde intramedullary nailing is often not suitable for the relatively small medullary cavity in adolescents. Another problem is the risk of impaired blood circulation depending on the entry point of the nail. The specially designed so-called adolescent lateral femoral nails are commercially available in smaller diameters. Due to its lateral entry point the risk of impaired blood flow is decreased. The choice of surgical therapy for femoral shaft fractures depends mainly on the young patient age and weight; therefore, different implant alternatives other than the ESIN technique for fracture stabilization may be selected.
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