Comparison of External Fixator and Flexible Intramedullary Nail (TEN) in Treatment of Pediatrics Lower Limb Grade III Open Fractures

Backgroud: Most pediatric open long bone fractures are the results of high energy trauma، and can lead to complications. The aim of this study is to compare the results of two commonly used operative techniques for tibial or femoral fractures; namely external fixator and flexible intrameduly rods.

In this clinical series، 42 children with 45 femoral or tibail open fractures from 2009 to 2011 who were treated by either external fixator (EF) (24 cases) or TEN (21 cases) were compared. In few cases combination of TEN and pin were used for more stability. The patients were evaluated and compared for infection، nonunion، malunion and refracture.

Bony union in the EF group was achieved in 3. 8 months and in TEN group in 3. 6 months (p≥. 05). In each group، 2 fracture-site infections without any evidence of osteomyelitis was obsereved. Five pin site infection in EF group needed changing the pin site. In TEN group early nail removal was necessary because of painful bursitis in one case at nail insertion site. There were 4 femoral refractures in EF group after frame removal. In 10 patients with TEN and extra pin no symptom or problem was seen.

In our study EF was effective as a definitive treatment. Flexible intramedullary nails were also effective and their results were similar to those of EF. Combination of TEN and pin caused more stability without any symptoms.