Health-Related Quality of Life after Adolescent Fractures of the Femoral Shaft Stabilized by a Lateral Entry Femoral Nail

Objectives Fractures of the femoral shaft in adolescents are commonly treated by elastic stable intramedullary nailing (ESIN). However, if the intramedullary canal is too narrow or the body weight is above 50kg, ESIN is not suitable. Alternative techniques include external fixation, submuscular plating, or rigid anterograde intramedullary rodding. Although the latter is commonly used in the adult population, it is rarely used in adolescents because of the risk to alter the blood supply to the femoral head or to damage the apophysis of the greater trochanter.

In our center we introduced intramedullary rodding for the treatment of the femoral shaft fractures that are not suitable for ESIN.

Questions We assessed the (1) demographics and complications of adolescents who were treated with intramedullary rodding using the adolescent lateral entry femoral nail (ALFN) for a fracture of the femoral shaft, the (2) health-related quality (HRQoL) of these adolescents, and if (3) HRQoL was associated with additional injuries.

Methods We were able to follow up on 15 adolescents (6 female, 9 male) who were treated with an ALFN for a diaphyseal femoral fracture from 2004 to 2017. Patients filled in a questionnaire that included the iHOT, the Pedi-IKDC, and the Peds-QL.

Results and Conclusion In thirteen patients the ALFN was used as the primary method of fixation, in two patients it was used for a failed elastic intramedullary nailing.

All 15 fractures healed radiographically. Complications consisted of a broken distal locking screw in one case, of which a fragment remained in situ during implant removal (Figure 4).

After a mean follow-up of 2.8 years, the patients had a mean iHOT-12 of 14.0 (SD 15.4), at a scale of 0-100, with lower values representing better HRQoL, and a mean Pedi-IKDC of 77.2 (SD 11.3). The mean function score of the PedsQL was 85.7 (SD 19.3), and the mean social score of the PedsQL was 86.2 (SD 12.5), both at a scale of 0-100, with higher values representing better HRQoL. Patients who sustained additional injures had consistently lower HRQoL scores than patients in whom the femoral fracture was the only injury.

Conclusions The treatment of diaphyseal fractures in adolescents with an ALFN results in good radiographic outcomes in all cases examined in this cohort. HRQoL, as measured by the iHOT, the Pedi-IKDC and the Peds-QL was good to excellent; however it was consistently lower in patients who sustained additional injuries. This indicates that the ALFN is a good alternative in patients not suitable for ESIN, and that the HRQoL of adolescents who were treated with an ALFN is mainly influenced by the presence of additional injures, and less by the fracture of the femur itself.

Stichwörter femur fracture; adolescent; surgery; intramedullary rodding; blood supply; Peds-QL; health-related quality of life

Publication History

Article published online:
15 October 2020