Safety of Conventional Interlocking Nails in Stabilizing Adolescent Femoral Shaft Fractures: A 14-Year Analysis

Trochanteric entry nails are the standard of care for adolescents with femoral shaft fractures. This implant was introduced in the last decade and is not widely available across all the centers. We have been using the conventional adult intramedullary interlocking nails to stabilize these fractures for more than 15 years and this study was done to analyze their outcomes.

We retrospectively collected the data of all femoral shaft fractures in children less than 18 years treated with intramedullary interlocking nail between 2006 and 2020, in our institution. The time to union, union rates, and complications including avascular necrosis (AVN) were analyzed based on the serial radiographs. The final functional and radiological outcomes were also analyzed for difference between trochanteric entry and piriformis fossa entry.

We had 103 children with 105 femoral fractures with an average age of 16.5 years (range 13-18 years). Piriformis entry was used in 47 and greater trochanteric (GT) entry was done in 58. The average follow-up was 18.2 months. No osteonecrosis was seen in either group. There was no significant difference in the rate of union in both groups. The incidence of heterotopic ossification was slightly higher in the trochanteric entry nailing, but not statistically significant. There was no difference in the final functional and radiological outcomes.

This is the first study to report the safety of usage of conventional femoral interlocking nails to treat femoral fractures in adolescents. We found that conventional interlocking nail can be safely used in adolescents.