Femoral head avascular necrosis associated with intramedullary nailing in an adolescent

An adolescent developed avascular necrosis of the femoral head after intramedullary nailing for a femoral diaphyseal fracture. This complication is most likely secondary to injury to the posterior superior ascending branch of the medial circumflex artery at the time of rod insertion. This artery is situated close to the proximal insertion hole just posterior to the trochanteric notch and piriformis fossa. Other methods of fracture treatment, either operative or nonoperative, should be considered in skeletally immature patients.