Does postoperative immobilization affect final alignment of pediatric femur fractures treated with flexible intramedullary nailing?
Location
LSUHSC-NO Center for Advanced Learning and Simulation
Document Type
Presentation
Start Date
21-6-2025 8:45 AM
End Date
21-6-2025 9:05 AM
Publication Date
June 2025
Description
Introduction: Flexible intramedullary nail (FIN) fixation of pediatric femur fractures is a popular method of fixation in children. Typical immobilization options include spica casting, long leg cast, knee immobilizers, or no immobilization and the decision to use each is usually left to surgeon preference. Our primary aim is to evaluate whether different postoperative immobilization status influences outcomes, namely radiographic alignment at the time of healing.
Methods: A retrospective chart review was conducted of all patients with femur fractures treated with FIN fixation at a pediatric hospital from April 2018 through July 2022. Postoperative immobilization protocols were recorded and separated into two groups, patients who were immobilized (IMM) and patients who were not immobilized (NoIMM). Radiographs were evaluated for fracture alignment immediately following surgery and at the time of healing. Patients’ demographic, fracture, and postoperative clinical characteristics were compared between the two groups (NoIMM vs. IMM). A total of 41 patients were treated for diaphyseal femur fractures with FINs at our institution during the study period.
Results: A total of 41 patients were treated for diaphyseal femur fractures with FINs at our institution during the study period. Twenty two fractures were classified as length stable (10 transverse, 12 short oblique). Nineteen fractures were classified as length unstable (14 long oblique, 5 comminuted). The IMM group was composed of 5 patients treated with casting (4 single leg spica casts, 1 long leg cast) and 22 with knee immobilizer, while the remaining 14 patients with no immobilization postoperatively constituted the NoIMM group. Notably, one surgeon allowed all patients to weight bear as tolerated without immobilization regardless of fracture stability (10 of the 14 patients in the NoIMM group). Our results suggest that either immobilization or no immobilization after flexible intramedullary nailing of pediatric femoral shaft fractures are viable options for reliable fracture healing.
Conclusion: In this study, lack of immobilization did not lead to loss of alignment, nor worse final alignment and had less complications than the immobilization group. Further research in this area would be valuable, particularly examining whether immobilization improves postoperative pain control. This investigation would likely require a well-planned prospective study. A larger study would also be valuable in evaluating immobilization of length stable vs. unstable fractures treated with flexible nails as there is no consensus currently in the literature on the subject and a very large sample size will be needed for adequate power. This investigation would likely require a multicenter study.
Recommended Citation
Miller, Adam MD, "Does postoperative immobilization affect final alignment of pediatric femur fractures treated with flexible intramedullary nailing?" (2025). Dept. of Orthopaedics: Robert D. D’Ambrosia Lectureship & Research Day. 3.
https://digitalscholar.lsuhsc.edu/ortho_rd/2025/presentation1/3
Does postoperative immobilization affect final alignment of pediatric femur fractures treated with flexible intramedullary nailing?
LSUHSC-NO Center for Advanced Learning and Simulation
Introduction: Flexible intramedullary nail (FIN) fixation of pediatric femur fractures is a popular method of fixation in children. Typical immobilization options include spica casting, long leg cast, knee immobilizers, or no immobilization and the decision to use each is usually left to surgeon preference. Our primary aim is to evaluate whether different postoperative immobilization status influences outcomes, namely radiographic alignment at the time of healing.
Methods: A retrospective chart review was conducted of all patients with femur fractures treated with FIN fixation at a pediatric hospital from April 2018 through July 2022. Postoperative immobilization protocols were recorded and separated into two groups, patients who were immobilized (IMM) and patients who were not immobilized (NoIMM). Radiographs were evaluated for fracture alignment immediately following surgery and at the time of healing. Patients’ demographic, fracture, and postoperative clinical characteristics were compared between the two groups (NoIMM vs. IMM). A total of 41 patients were treated for diaphyseal femur fractures with FINs at our institution during the study period.
Results: A total of 41 patients were treated for diaphyseal femur fractures with FINs at our institution during the study period. Twenty two fractures were classified as length stable (10 transverse, 12 short oblique). Nineteen fractures were classified as length unstable (14 long oblique, 5 comminuted). The IMM group was composed of 5 patients treated with casting (4 single leg spica casts, 1 long leg cast) and 22 with knee immobilizer, while the remaining 14 patients with no immobilization postoperatively constituted the NoIMM group. Notably, one surgeon allowed all patients to weight bear as tolerated without immobilization regardless of fracture stability (10 of the 14 patients in the NoIMM group). Our results suggest that either immobilization or no immobilization after flexible intramedullary nailing of pediatric femoral shaft fractures are viable options for reliable fracture healing.
Conclusion: In this study, lack of immobilization did not lead to loss of alignment, nor worse final alignment and had less complications than the immobilization group. Further research in this area would be valuable, particularly examining whether immobilization improves postoperative pain control. This investigation would likely require a well-planned prospective study. A larger study would also be valuable in evaluating immobilization of length stable vs. unstable fractures treated with flexible nails as there is no consensus currently in the literature on the subject and a very large sample size will be needed for adequate power. This investigation would likely require a multicenter study.
Comments
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