Yonsei Med J.  2012 Mar;53(2):408-415. 10.3349/ymj.2012.53.2.408.

Treatment of Femoral Shaft Fracture with an Interlocking Humeral Nail in Older Children and Adolescents

• Park H
• Kim HW

• KMID: 1120210
• DOI: http://doi.org/10.3349/ymj.2012.53.2.408

Abstract

PURPOSE
Rigid interlocking nailing for femoral shaft fracture is ideal for use in adolescents in terms of stability of the fracture and convenience for the patient. However, numerous authors have reported that rigid interlocking nailing has some limitations in this age group due to the risk of complications. We evaluated the results of intramedullary nailing for femoral shaft fractures with an interlocking humeral nail in older children and adolescents.
MATERIALS AND METHODS
We retrospectively reviewed records of patients treated with an interlocking humeral nail. Radiographs were examined for proximal femoral change and evidence of osteonecrosis. Outcomes were assessed by major or minor complications that occurred after operative treatment.
RESULTS
Twenty-four femoral shaft fractures in 23 patients were enrolled. The mean age at the time of operation was 12 years and 8 months and the mean follow-up period was 21 months. Bony union was achieved in all patients without any complications related to the procedure such as infection, nonunion, malalignment and limb length discrepancy. All fractures were clinically and radiographically united within an average eight weeks. No patients developed avascular necrosis of the femoral head and coxa valga.
CONCLUSION
Intramedullary nailing through the greater trochanter using a rigid interlocking humeral nail is effective and safe for the treatment of femoral shaft fractures in older children and adolescents.

Keyword

Children; adolescent; femoral shaft fracture; interlocking humeral nail; greater trochanter

MeSH Terms

Adolescent
*Bone Nails
Child
Female
Femoral Fractures/*surgery
Femur/injuries/surgery
Humans
Male
Retrospective Studies
Treatment Outcome

Figure

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  Fig. 1 The design of the unreamed humeral nail shows medial bending of the proximal nail end by 5°.

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  Fig. 2 A boy aged 11 years and 9 months (patient No. 3) had a shaft fracture of the femur. Preoperative anteroposterior and lateral radiographs (A) show the proximal 1/3 shaft spiral fracture. Immediate postoperative anteroposterior and lateral radiographs (B) show internal fixation with unreamed humeral nail via the tip of the greater trochanter. Postoperative three-month follow-up anteroposterior and lateral radiographs (C) show bony union without complications. The boy has neither subjective nor objective discomfort with a full weight-bearing gait. The fifteen-month postoperative scanogram (D) after hardware removal shows no leg length discrepancy deformity or distortion of the proximal femoral area.

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