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Twenty-Year Experience with Rigid Intramedullary Nailing of Femoral Shaft Fractures in Skeletally Immature Patients

Crosby, Samuel N. Jr. MD; Kim, Elliott J. MD; Koehler, Daniel M. MD; Rohmiller, Michael T. MD; Mencio, Gregory A. MD; Green, Neil E. MD; Lovejoy, Steven A. MD; Schoenecker, Jonathan G. MD, PhD; Martus, Jeffrey E. MD, MS

Journal of Bone & Joint Surgery - American Volume: 2 July 2014 - Volume 96 - Issue 13 - p 1080–1089
doi: 10.2106/JBJS.M.01128
Scientific Articles

Background: Debate exists over the safety of rigid intramedullary nailing of femoral shaft fractures in skeletally immature patients. The goal of this study was to describe functional outcomes and complication rates of rigid intramedullary nailing in pediatric patients.

Methods: A retrospective review was performed of femoral shaft fractures in skeletally immature patients treated with trochanteric rigid intramedullary nailing from 1987 to 2009. Radiographs made at initial injury, immediately postoperatively, and at the latest follow-up were reviewed. Patients were administered the Nonarthritic Hip Score and a survey.

Results: The study population of 241 patients with 246 fractures was primarily male (75%) with a mean age of 12.9 years (range, eight to seventeen years). The majority of fractures were closed (92%) and associated injuries were common (45%). The mean operative time was 119 minutes, and the mean estimated blood loss was 202 mL. The mean clinical follow-up time was 16.2 months (range, three to seventy-nine months), and there were ninety-three patients with a minimum two-year clinical and radiographic follow-up. An increase of articulotrochanteric distance of >5 mm was noted in 15.1% (fourteen of ninety-three patients) at a minimum two-year follow-up; however, clinically relevant growth disturbance was only observed in two patients (2.2%) with the development of asymptomatic coxa valga. There was no femoral head osteonecrosis. Among the 246 fractures, twenty-four complications (9.8%) occurred. At the time of the latest follow-up, 1.7% (four of 241 patients) reported pain. The average Nonarthritic Hip Score was 92.4 points (range, 51 to 100 points), and 100% of patients reported satisfaction with their treatment.

Conclusions: Rigid intramedullary nailing is an effective technique for treatment of femoral shaft fractures in pediatric patients with an acceptable rate of complications.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children’s Hospital, 4202 DOT, 2200 Children’s Way, Nashville, TN 37232-9565. E-mail address for J.E. Martus:

2Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242

3Beacon Orthopedics and Sports Medicine, 500 E-business Way, Sharonville, OH 45241

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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