Intramedullary nailing of the femur in children. Effects on its proximal end
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Published on: November 13, 2016
P González-Herranz1, J Burgos-Flores, J M Rapariz
1Ramón y Cajal Hospital, Alcalá de Henares University, Madrid, Spain.
Insights
Femoral intramedullary nailing in children can cause hip abnormalities, particularly in those under 13. Damage to the trochanterocervical growth plate is a concern, especially with piriform fossa insertion.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Biomedical engineering
Background:
- Femoral intramedullary nailing is a common orthopedic procedure for pediatric fractures.
- Potential complications, especially concerning growth plate integrity, require thorough investigation.
- Long-term outcomes of this surgical technique in children are not fully elucidated.
Purpose of the Study:
- To evaluate the medium- and long-term effects of femoral intramedullary nailing in pediatric patients.
- To identify specific complications related to the procedure and their influencing factors.
- To provide recommendations for optimizing surgical techniques and patient selection.
Main Methods:
- Retrospective study of 34 children undergoing femoral intramedullary nailing.
- Assessment of medium- and long-term radiographic outcomes, focusing on proximal femur abnormalities.
- Analysis of potential risk factors including patient age, insertion technique, and implant characteristics.
Main Results:
- A high incidence of proximal femur abnormalities was observed, including coxa valga and growth arrest of the greater trochanter.
- These growth plate-related disorders affected 30% of patients, predominantly those under 13 years old.
- Piriform fossa insertion was associated with a higher frequency of these abnormalities.
Conclusions:
- Femoral intramedullary nailing in children under 13 is associated with significant risks of trochanterocervical growth plate damage.
- Alternative management strategies should be considered for younger pediatric patients to mitigate these risks.
- Surgeons should exercise caution with piriform fossa insertion in pediatric femoral nailing.
Abstract:
We have studied the medium- and long-term effects of femoral intramedullary nailing in 34 children. There was a high incidence of abnormality at the proximal end of the femur, including coxa valga, arrest of growth of the greater trochanter and thinning of the neck of the femur, because of damage to the trochanterocervical growth plate. These disorders affected 30% of the patients, mostly under the age of 13 years (p < 0.05), and were seen more frequently when the nail had been introduced through the piriform fossa. Other factors, such as the side, gender, aetiology, proximal or retrograde insertion, the size of nail and removal of the implant did not influence the result. We recommend that in patients under the age of 13 years other methods of management should be used to avoid damage to the growth plate.
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