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We just came back from a medical conference about the best way to treat our son who has a broken leg. Evidently his weight (200 pounds) and age (13 years old) along with the type of fracture are making this a more complex problem than we ever imagined. The surgeons thought it would be okay to use a titanium nail down inside the bone even though he weighs so much. The final decision is ours to make but we don't really know what to say. What can you tell us about these nails?
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Broken bones are a common calamity among children. But young children seem to have an amazing ability to heal and heal well. Fractures of the femur (thigh bone) become more problematic as children get older, larger in size, and heavier.
Studies have been done in younger children with femoral fractures to determine the best way to surgically restore bone alignment with pins, nails, plates, and screws. But surgeons can't rely on that data when working with older children and teens.
In order to find the optimal way to hold the broken pieces together in more complex femoral fractures in teens, surgeons from The Hospital for Sick Children in Toronto, Ontario (Canada) conducted this study. They went back into their medical records and pulled the medical records of all children ages 11 to 18 who had traumatic femoral fractures.
They compared the results of treatment based on four different ways to surgically fix (hold in place) the broken bones. The four methods of fixation included: 1) elastic stable intramedullary nail fixation, 2) external fixation, 3) rigid intramedullary nail fixation, and 4) plate fixation.
Results were measured using length of hospital stay, time to heal (bone union), development of complications, and the need for a second operation. X-rays taken at the time of surgery and postoperatively were reviewed. They also looked at the type and number of complications associated with each fixation method.
The elastic titanium nails are meant to have some give so that the force of the bone lengthening with a growth spurt won't cause a problem. But they can potentially bend, shift, and even break under the load of some heavier patients.
The study mentioned here didn't find any problem with using the elastic titanium nails even in patients who weighed up to 225 pounds. Children who are treated with an external fixation device (pins in the bone, rod outside the leg) seem to have the most problems.
Patient and family preferences are always important in major surgical decisions. But sometimes when you are just outside your comfort zone and lack the knowledge needed, it's wise to trust the expertise and experience of your surgeon who will be making the final decision.
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