Two Techniques for Retrograde Flexible Intramedullary Fixation of XXXX : All-Lateral Entry Versus Medial and Lateral Entry Point.

@entity5251 @entity1 @entity532 @entity174
BACKGROUND: Multiple techniques for flexible intramedullary nailing (FIMN) of pediatric @entity174 have been described. To our knowledge, no study has compared combined medial-lateral (ML) entry versus @entity5251 ( @entity5251 ) entry retrograde nailing. This study compares surgical outcomes, radiographic outcomes, and complication rates between these 2 techniques. METHODS: A retrospective review of a consecutive series of @entity1 treated by retrograde, dual FIMN of @entity174 was performed from 2005 to 2012. Demographics and operative data were recorded. Radiographs were analyzed for @entity174 pattern, @entity174 location, percent canal fill by the nails, as well as shortening and angulation at the time of osseous union. Rates of symptomatic implants and their removal were noted. Data were compared between @entity1 treated with medial and lateral entry (ML group) nailing and those treated with @entity5251 entry ( @entity5251 group) nailing using the Student t test and correlation statistics. RESULTS: Of the 244 @entity1 with femoral shaft fractures treated with retrograde FIMN using Ender stainless steel nails, 156 were in the ML group and 88 were in the @entity5251 group. There were no statistical differences in sex (74% vs. 82% males), age (8.0 vs. 8.6 y), weight (29.4 vs. 31.1 kg), or @entity174 pattern between the 2 groups. The average total anesthesia time was less in the @entity5251 group (133 vs. 103 min) (P<0.0001). There was no difference between the techniques in shortening (3.9 vs. 3.0 mm), coronal angulation (2.9 vs. 2.6 degrees), or sagittal angulation (3.3 vs. 2.7 degrees) at union. In the @entity5251 group, there was a correlation between canal fill and reduced shortening at union. No differences were found in the presence or degree of varus alignment, procurvatum deformity, or recurvatum angulation between the constructs. There were 5 malunions in the @entity5251 group and 9 malunions in the ML group (5.7% vs. 5.8%, P=1). The incidence of having a healed femur @entity174 with >10 degrees of valgus was higher in the @entity5251 group (0% vs. 3.4%) (P=0.04). There were no differences between the groups in the rate of symptomatic implant @entity532 . CONCLUSIONS: The @entity5251 entry technique for FIMN of pediatric @entity174 is 30 minutes faster without worse final @entity174 alignment, additional complications, or increased rates of symptomatic implants. When using the @entity5251 technique, specific attention should be paid to percentage of canal fill and ensuring that the @entity174 is not reduced in a valgus position. LEVEL OF EVIDENCE: Level III-therapeutic.
