Intramedullary Nailing of Pediatric Femoral Shaft Fracture

Submuscular Bridge Plating for Complex Pediatric Femur Fractures Is Reliable

“…Very proximal and distal fractures are still difficult to treat with rigid nails [12,18,20,26]. There is a risk for growth arrest of the greater trochanter apophysis resulting in coxa valga and heterotopic bone formation when violating the trochanteric physis [18]. Classical compression plating, with a long incision and more soft tissue damage, has a higher risk of infection and delayed healing, with a reported reoperation rate of 10% [3].…”

“…Rigid nailing needs to be performed with an entrance point lateral to the tip of the trochanteric physis to avoid injury to proximal femur blood vessels and only in older patients who have a medullary canal large enough for nail passage. Very proximal and distal fractures are still difficult to treat with rigid nails [12,18,20,26]. There is a risk for growth arrest of the greater trochanter apophysis resulting in coxa valga and heterotopic bone formation when violating the trochanteric physis [18].…”

“…External fixation has been associated with a refracture rate of 22%, malalignment rate of 20%, and pin tract infection rate of 70% [28]. Rigid intramedullary devices are used routinely in adults, but in children there is a serious risk of damaging the vascular supply to the femoral head, resulting in avascular necrosis of the femoral head when using piriformis fossa or even greater trochanter entry points [2,17,18,26]. Rigid nailing needs to be performed with an entrance point lateral to the tip of the trochanteric physis to avoid injury to proximal femur blood vessels and only in older patients who have a medullary canal large enough for nail passage.…”

Flexible Intramedullary Nail Fixation in Paediatric Femoral Shaft Fractures

“…In children of age 13 years or more, rigid antegrade intramedullary nailing has become the standard of care [22][23][24] . Some authors have advocated the use of rigid nailing in children younger than 13 years of age also [25] , but the concern of iatrogenic complications like femoral head avascular necrosis (AVN) [26][27] and proximal femoral growth disturbance [27,28] , have led others to limit its use to primarily older children.…”

Intramedullary nails for pediatric diaphyseal femur fractures in older, heavier children: Early results

“…Furthermore, rigid IMNs inserted laterally to the greater trochanter tip have been used successfully for treatment of pediatric femur fractures, but these were modified nails, not designed for this purpose or point of entry [20,[26][27][28]. There is limited evidence in the literature supporting the use of rigid nails for pediatric femur fractures [29], as shown in the recent AAOS practice guideline summary [30]. We describe here an exploratory investigation of the use of a new lateral entry intramedullary device specifically designed for treatment of femoral fractures for adolescent patients weighing more than 45.5 kg (100 pounds) that results in satisfactory union with a minimally invasive insertion procedure.…”