Intramedullary Nailing of Femoral Shaft Fractures in Children - Benefits and Risks

Abstract

Pediatric femoral fractures should be treated operatively by using intramedullary techniques whenever possible. Definitive treatment by using flexible rods or antegrade locking nails avoids secondary fracture displacement and allows early ambulant treatment of the child. Disadvantages of antegrade intramedullary nailing procedures in the past were due to approaches passing the piriformis fossa. Recently published data of MRI studies following antegrade nailing through a trochanteric approach have shown neither avascular necrosis nor valgus deformity. By using an 8.5 mm antegrade nail made for insertion via the trochanter tip in 15 fractures we did not have any perioperative complications. We have not seen any avascular necrosis at the time of hardware removal as yet. In the younger patients up to 10-11 years, ESIN is an adequate and safe way to stabilize the fracture, reducing hospitalization time and allowing early weight-bearing. From the age of nine to eleven until the time of skeletal maturity, adolescents may be treated by intramedullary, specially designed nails, using a dorsolateral approach through the greater trochanter.

Key words

Femoral shaft fracture - children - pediatric femoral fracture - nail

References

• 1 Agus H, Kalenderer Ö, Eryanilmaz G, Ömeroglu H. Biological internal fixation of comminuted femur shaft fractures by bridge plating in children.  J Pediatr Orthop. 2003;  23 184-189
• 2 Beaty J H, Austin S M, Warner W C, Canale S T, Nicols L. Interlocking intramedullary nailing of femoral fractures in adolescents - Preliminary report and complications.  J Pediatr Orthop. 1994;  14 178-183
• 3 Bengner U, Ekbohm T, Johnell O, Nilsson B E. Incidence of femoral and tibial shaft fractures.  Acta Orthop Scand. 1990;  61 251-254
• 4 Buckley S L. Current trends in the treatment of femoral shaft fracture in children and adolescents.  Clin Orthop. 1997;  338 60-73
• 5 Buford D, Christensen K, Weatherall P. Intramedullary nailing of femoral fractures in adolescents.  Clin Orthop. 1998;  350 85-89
• 6 Gordon J E, Swenning T A, Burd T, Szymanski D A, Schoenecker P L. Radiographic changes after lateral transtrochanteric intramedullary nail placement in children.  J Bone Joint Surg [Am]. 2003;  85 1295-1301
• 7 Hakala B E, Blanco J S. Pediatric femoral shaft fracture.  Medscape Orthopaedics and Sports Medicine. 2000;  4 1-15 http://www.medscape.com/medscape/OrthoSportsMed
• 8 Khanna N, Gordon J E, Ortman M, Bassett G S, Schoenecker P L. Intramedullary nailing of femoral fractures in children through the greater trochanter using a rigid, bent nail. Abstract no. 136. AAOS, San Francisco 2001
• 9 Kregor P J, Song K M, Routt M L, Sangeorzan B J, Liddell R M, Hansen S T. Plate fixation of femoral shaft fractures in multiply injured children.  J Bone Joint Surg [Am]. 1993;  75 1774-1780
• 10 Krettek C, Haas N, Walker J, Tscherne H. Treatment of femoral shaft fractures in children by external fixation.  Injury. 1991;  22 263-266
• 11 Linhart W E, Roposch A. Elastic stable intramedullary nailing for unstable femoral fractures in children: preliminary results of a new method.  J Trauma. 1999;  47 372-378
• 12 McCartney D, Hinton A, Heinrich S D. Operative stabilization of paediatric femur fractures.  Orthop Clin North Am. 1994;  25 635-650
• 13 Orler R, Hersche O, Helfet D L, Mayo K A, Ward T, Ganz R. Avascular necrosis of the femoral head as a serious complication following femoral nailing in children and adolescents.  Unfallchirurg. 1998;  101 495-499
• 14 Pape H C, Krettek C. Management of fractures in the severely injured - Influence of the principle of “damage control orthopaedic surgery”.  Unfallchirurg. 2003;  106 87-96
• 15 Raney E M, Ogden J A, Grogan D P. Premature greater trochanteric epiphysiodesis secondary to intramedullary femoral roding.  J Paediatric Orthop. 1993;  13 516-520
• 16 Sahlin Y. Occurrence of fractures in a defined population: a 1-year study.  Injury. 1990;  21 158-160
• 17 Saxer U. Die Frakturheilung bei Kindern und Jugendlichen. In: Weber BG (ed). Springer, Heidelberg 1979; 272-297
• 18 Schmittenbecher P P, Dietz H G, Linhart W E, Slongo T. Complications and problems in intramedullary nailing of children's fractures.  European Journal of Trauma. 2000;  26 287-293
• 19 Skags D L, Leet A I, Money M D, Shaw B A, Hale J H, Tolo V T. The use of external fixation in the treatment of femur shaft fractures in children. Paper presented at the 1998 Annual Meeting of the Paediatric Orthopaedic Society of North America. May 7, 1998
• 20 Tolo T T. Orthopaedic treatment of fractures of the long bones and pelvis in children who have multiple injuries. An Instructional Course Lecture, AAOS.  J Bone Joint Surg [Am]. 2000;  82 272-280
• 21 Townsend D R, Hoffinger S. Intramedullary nailing of femoral shaft fractures in children via the trochanter tip.  Clin Orthop. 2000;  376 113-118
• 22 Weinberg A M, Hasler C C, Leitner A, Lampert C, Laer L von. External fixation of paediatric femoral shaft fractures. Treatment and results of 121 fractures.  European Journal of Trauma. 2000;  26 25-32
• 23 Winquist R A, Hansen S T, Clawson K. Closed intramedullary nailing of femoral fractures.  J Bone Joint Surg [Am]. 1984;  66 529-539