CLOSED, LOCKED INTRAMEDULLARY NAILING OF PEDIATRIC FEMORAL SHAFT FRACTURES.

Abstract

Between 1999 and 2002 14 children with femoral shaft fractures were treated with closed, locked intramedullary nailing. There were 11 male and 3 female patients, aged 11–16 years (mean 14.4 years). All fractures were closed. There were 9 transverse, 1 pathologic, 1 bipolar, 1 malunited and 2 spiral fractures. The fractures occurred following MVA or falls from height. All fractures were reduced and closed locked intramedullary nailing was performed using small diameter titanium nails without reaming. The entrance of point of the nail was created at the tip of the greater trochanter and no traction was used intraoperatively. The mean hospital stay was 2 days and immediate partial weight-bearing was permitted.

All fractures united according to clinical and radiological criteria within 9 weeks. The maximum patient follow-up was 24 months (mean 17 months). Hip and knee mobility was full and no case of femoral head osteonecrosis, infection or malunion was ascertained.

Closed, locked intramedullary nailing in adolescent patients provides immediate fracture immobilization combining safety and limited morbidity. Meticulous adherence to the surgical technique is necessary respecting the developing upper part of the femur.