When treating pediatric femoral shaft fractures, flexible nails are a common and effective solution. However, to ensure the fracture stays reduced and heals properly, there are several critical technical points that must be followed. These steps help maintain stability, control torsion, and resist bending forces during the healing process.
1. Use the Largest Nail Possible
One of the first rules in flexible nailing is to use the largest nail possible. By maximizing the diameter of the nail, you increase the stability of the construct. Each nail should ideally be around 40% of the minimum diameter of the diaphysis. This ensures that the nails provide enough support without overstressing the bone or causing complications like nail migration.
- Key Points:
- Nail diameter should be 40% of the diaphyseal diameter.
- Larger nails = better stability.
- Helps resist torsional and bending forces.
2. Achieve 80% Canal Fill with Two Nails
To properly stabilize the fracture, it’s essential to use two nails and achieve approximately 80% canal fill. Using two nails helps balance the forces across the fracture site, providing better torsional control and resistance to bending. Achieving 80% fill ensures that the nails are snug enough within the canal to prevent movement while allowing for slight flexibility, which promotes bone healing.
- Key Points:
- Two nails are required for optimal stability.
- Aim for 80% canal fill.
- Provides torsional and bending resistance.
3. Prebend the Nails
Before insertion, the nails should be pre-bent to create a 30-degree C-shaped bend at the level of the fracture. This prebending increases the nails’ ability to resist bending forces and helps maintain the fracture reduction. Without prebending, the nails may not provide adequate stability, leading to loss of reduction or delayed healing.
- Key Points:
- Prebend nails to a 30-degree C-shaped bend.
- Bend should be at the fracture level.
- Helps resist bending forces and maintain reduction.
4. Opposite Bends of the Two Nails at the Fracture Site
To further improve stability, the two nails should have opposite bends at the fracture site. This technique ensures that the nails spread within the diaphysis, providing better torsional control and resistance to rotation. The opposite bends help lock the fracture in place and prevent it from slipping or rotating during healing.
- Key Points:
- Nails should have opposite bends at the fracture site.
- Ensures spread within the diaphysis.
- Improves torsional control and rotational stability.
5. Divergence of Rods in the Metaphysis
Lastly, ensure that the rods diverge within the metaphysis. This divergence is crucial for providing torsional control and ensuring the nails don’t migrate. The divergent positioning of the rods helps lock the nails into place, preventing them from sliding or rotating within the bone, which could lead to loss of reduction.
- Key Points:
- Rods should diverge in the metaphysis.
- Prevents migration and torsional instability.
- Ensures long-term stability of the fracture.
Conclusion: Mastering Flexible Nailing in Pediatric Femoral Shaft Fractures
By following these five technical points, you can significantly improve the outcomes of pediatric femoral shaft fractures treated with flexible nails. From using the largest nail possible to ensuring opposite bends at the fracture site, these techniques are designed to maximize stability and promote proper healing. For more detailed guidelines on pediatric fracture management, visit OrthoBullets.
Meta Description:
Learn the 5 key technical points for maintaining reduction of pediatric femoral shaft fractures using flexible nails, including nail size, prebending, and torsional control techniques.
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