Pediatric Femoral Shaft Fractures Treated with Greater-Trochanter-Entry Antegrade Rigid Nail in Level 1 Trauma Center

The treatment of pediatric femoral shaft fractures, especially in adolescents, presents unique challenges. This manuscript aims to report clinical outcomes associated with the use of greater-trochanter-entry antegrade rigid nail (GTARN) and provide insights on the age at which this method becomes safe.

This study is a retrospective review of cases who treated femoral shaft fractures using GTARN between 2006 and 2023. Fractures were classified according to the AO classification. Operative time, union time, duration of follow-up, and complications were reviewed. The study population was stratified into 2 age groups (<12 years and ≥12 years) in accordance with prior recommendations. Fisher's exact test was used to compare categorical variables between the groups. For the analysis of proximal femur development, femoral neck widths and femoral head sizes were recorded bilaterally on final radiographs. Paired samples t-test was used.

A total of 38 patients were included in the study. The mean age at the time of surgery was 13.4 ± 1.68 years. Complications were documented in 11 cases, including 5 cases of limb length discrepancies (LLDs), 4 cases of greater trochanter undergrowth, and 1 case of each valgus and varus deformity of the femur. All 5 LLDs were due to overgrowth of the fractured side. There was no reported coxa vara or coxa valga deformity. Notably, there were no cases of femoral head avascular necrosis (AVN). In addition, the younger group demonstrated a significantly higher rate of LLD complications compared to the older group. Femur neck widths and head sizes between fracture side and contralateral side displayed no distinct statistical significance.

The GTARN is an effective treatment option for femoral shaft fractures in adolescents. The use of this technique was not associated with femoral head AVN or proximal femur development. However, clinicians should be mindful that secondary complications, particularly LLDs exceeding 1 cm, may occur more frequently in patients under 12 years of age.   Cite this article as: Lee JW, Cho JH, Kim TH. Pediatric femoral shaft fractures treated with greater-trochanter-entry antegrade rigid nail in level 1 trauma center. Acta Orthop Traumatol Turc., 2026; 60(2), 0489, doi:10.5152/j.aott.2026.25489.