Initial Results of the Treatment of Femoral Shaft Fractures in Children Using the Trigen Trochanteri

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Initial Results of the Treatment of Femoral Shaft
Fractures in Children Using the Trigen
Trochanteric Antegrade Nail

• Susan Haralabatos, MD Zhanna Sikorski, RPAC
• Stony Brook University Medical Center, New York
• The Trigen Trochanteric Antegrade Nail (TAN) has
  been designed for the treatment of femur
  fractures in the pediatric population. The
  purpose of this study is to report the initial
  results of the treatment of pediatric femoral
  shaft fractures using this device.

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Features of the TAN Nail

• 8.5mm diameter
• Trochanteric entry point
• Proximal interlock two options
• Standard
• Reconstruction mode
• Distal interlock two options
• Now made for right left
• Manufactured by Smith Nephew

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Methods Results

• The results of 20 fractures in 19 patients over
  a six year period were reviewed. All patients
  were followed clinically and radiographically All
  patients were treated with an 8.5mm TAN Nail.
• 17 male, 2 female
• Average age 13 years, 10 months (9-17)
• Mechanism
• 6 sports injury
• 8 passenger involved in an auto accident
• 5 struck by auto
• 9 patients sustained other significant injuries
• Other fractures in 8 patients
• Head trauma in 7 patients

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Methods Results

• Surgery was performed supine on a radiolucent
  table
• Proximal end caps were used in all patients
• Four patients required open reduction
• Isolated injuries were discharged 3.5 days
  post-op (2-6)
• 8 patients required discharge to a rehabilitation
  hospital for multiple injuries
• 2 patients were lost to follow-up
• 3 patients were excluded from analysis as their
  follow-up was less than 6 months

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Results

• Full motion of the hip knee 4-6 weeks post-op
• Weightbearing status was determined by fracture
  pattern and other injuries, with full
  weightbearing by 8 weeks
• Patients returned to unrestricted activity within
  4 months of injury
• Average length of follow-up was 22 months (5 50
  months)
• Removal has been performed in 10 patients
• Average 12 months post-injury (6-22 months)

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Results

• No limb length inequality
• No rotational malalignment
• No avascular necrosis
• All fractures healed
• Complications
• 3 hypertrophic scar
• 1 painful hardware
• 1 heterotopic ossification

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ILLUSTRATIVE CASE9 year old boy struck by auto
while riding motor bike. No other injuries. These
are intra-operative films.
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2 months Post-op
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8 months Post-op
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Conclusions and Significance

• Static, locked intramedullary nailing using the
  Trigen trochanteric antegrade nail can be
  performed in young children prior to physeal
  closure. Preliminary results are promising and
  show this technique is effective in allowing
  healing and early return of function with minimal
  morbidity. Continued experience and long-term
  follow-up will determine if intramedullary
  fixation of femur fractures becomes the treatment
  of choice in the pediatric age group.