Session V Pediatrics

Saturday, September 28, 1996 Session V, 11:10 a.m.

Locked Intramedullary Nailing of Femoral Shaft Fractures in Adolescents

James H. Beaty, MD, Martin J. Herman, MD, A. Paige Whittle, MD

Campbell Clinic-University of Tennessee, Department of Orthopaedic Surgery, Memphis TN

Purpose: To determine the safety and efficacy of locked intramedullary nailing of femoral fractures in adolescents.

Materials & Methods: Between June of 1987 and September of 1994, 52 femoral fractures in 51 adolescents were stabilized with locked intramedullary nailing. Forty-nine fractures were closed and 3 were open. There were 15 females and 37 males, ranging in age from 9+11 years to 15+5 years (average age 12+7 years). All nails were inserted with a reamed technique and all were statically locked. Nail diameter averaged 10 mm (range 8 to 12 mm). Forty-nine nails were inserted through a portal in the piriformis fossa, and 3 were inserted through the greater trochanter.

Results: Followup averaged 36.2 months (range 14 to 68 months). All fractures united; there were no malunions or infection. There were 2 post operative transient peroneal nerve palsies. Leg length discrepancy averaged 0.7 cm. Two patients had leg length discrepancies of 2.2 cm overgrowth which could not be explained by concomitant injuries. The articulotrochanteric distance (ATD) was used as a measurement of proximal femoral growth disturbance. Six patients had more than 1 cm differences in the ATDs of the injured and normal sides. None of these patients had hip complaints, gait disturbances or subsequent acetabular dysplasia. Segmental avascular necrosis of the femoral head developed in one female patient who was 11+6 years of age at the time of injury.

Conclusions: Locked intramedullary nailing is a safe and effective method for the treatment of femoral fractures in adolescents. There is a small risk of overgrowth in adolescents with more than 2 years of skeletal growth remaining. Radiological changes in proximal femoral growth did not yield clinical symptoms or acetabular dysplasia. Technique modification is recommended in adolescents, with nail insertion through the greater trochanter instead of the piriformis fossa to decrease the risk of avascular necrosis.