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Twenty-Year Experience with Rigid Intramedullary Nailing of Femoral Shaft Fractures in Skeletally Immature Patients
Samuel N Crosby1, Elliott J Kim1, Daniel M Koehler2
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: jeff.martus@vanderbilt.edu.
Insights
Rigid intramedullary nailing effectively treats pediatric femoral shaft fractures, showing good functional outcomes and low complication rates. This study confirms its safety and efficacy in young patients.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- The safety of rigid intramedullary nailing for pediatric femoral shaft fractures remains debated.
- This study evaluates functional outcomes and complication rates in skeletally immature patients.
Purpose of the Study:
- To assess the efficacy of rigid intramedullary nailing in treating pediatric femoral shaft fractures.
- To report functional outcomes and complication rates associated with this surgical technique.
Main Methods:
- Retrospective review of 246 femoral shaft fractures in skeletally immature patients (1987-2009).
- Analysis of radiographic and clinical data, including Nonarthritic Hip Score and patient surveys.
- Minimum two-year follow-up for 93 patients to assess growth disturbances and long-term outcomes.
Main Results:
- 241 patients (246 fractures) with a mean age of 12.9 years; 92% closed fractures.
- 15.1% showed articulotrochanteric distance increase, with only 2.2% developing asymptomatic coxa valga.
- Overall complication rate was 9.8% (24/246 fractures), with 1.7% reporting pain at latest follow-up. No femoral head osteonecrosis.
- Average Nonarthritic Hip Score was 92.4; 100% patient satisfaction.
Conclusions:
- Rigid intramedullary nailing is a safe and effective treatment for pediatric femoral shaft fractures.
- The technique yields acceptable complication rates and high patient satisfaction.
- Functional outcomes are generally good, with minimal clinically relevant growth disturbances.
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.
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