Effectiveness of rigid interlocking nails through tip of greater trochanter for fixation of femur shaft fracture in adolescent_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHANG Lei , ZUO Yuming , WANG Yueguang , ZHOU Hongyan , YU Tieqiang , YI Fan , WANG Binggang , LIU Na

Department of Pediatric Orthopedics, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China;

Corresponding author：

ZHANG Lei, Email: xp30000@sina.com

Keywords：

Rigid interlocking nail; femur shaft fracture; greater trochanter; adolescent

DOI：

10.7507/1002-1892.201609082

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Objective To explore the effectiveness of rigid interlocking nails through the tip of the greater trochanter for fixation of femur shaft fracture in adolescent. Methods A retrospective analysis was made on the clinical data of 23 adolescents with femoral shaft fractures treated between June 2011 and June 2015. Of 23 cases, 19 were male and 4 were female, aged from 13 years and 6 months to 17 years (mean, 15.2 years), weighed from 40 to 77 kg (mean, 53.5 kg). The causes were traffic accident injury in 13 cases, sports injury in 7 cases, and falling injury in 3 cases. Fracture located at the proximal 1/3 in 6 cases, middle 1/3 in 10 cases, and distal 1/3 in 7 cases; fracture was typed as transverse in 10 cases, oblique in 6 cases, spiral in 1 case, and comminuted in 6 cases. The course of disease was 3-17 days (mean, 6.2 days). At last follow-up, the leg length discrepancy, femoral neck shaft angle, femoral neck diameter, and articulotrochanteric distance (ATD) were measured on the X-ray films. Results Wounds healed in all patients, and no infection occurred. All patients were followed up 15-36 months (mean, 26.5 months). The patients had no pain and had normal gait, without lameness. The X-ray films showed bone healing at 5-13 months (mean, 6.5 months). No nonunion, delayed union, malunion of more than 5 °, or rotational deformity occurred. The removal time of internal fixations was 12-24 months (mean, 19.5 months) after operation. No heterotopic ossification, re-fracture, proximal femoral deformity, or femoral head necrosis occurred during follow-up. Two patients had early epiphyseal closure of greater trochanter, which had no impact on gait; leg-length inequality of less than 1 cm was observed in 2 cases. At last follow-up, the neck shaft angle, femoral neck diameter, and ATD of normal and affected sides were (131.7±6.3) and (132.9±7.8)°, (34.1±3.2) and (33.9±3.8) mm, and (27.8±9.2) and (26.5±8.5) mm, showing no significant difference between two sides (t=–0.24,P=0.86;t=0.18,P=0.92;t=1.03,P=0.49). Conclusion It is a reliable and effective method to use rigid interlocking nails inserted through the tip of the greater trochanter for the fixation of femur shaft fracture in adolescent.

Citation： ZHANG Lei, ZUO Yuming, WANG Yueguang, ZHOU Hongyan, YU Tieqiang, YI Fan, WANG Binggang, LIU Na. Effectiveness of rigid interlocking nails through tip of greater trochanter for fixation of femur shaft fracture in adolescent. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(3): 262-265. doi: 10.7507/1002-1892.201609082 Copy

1.	Gardner MJ, Lawrence BD, Griffith MH. Surgical treatment of pediatric femoral shaft fractures. Curr Opin Pediatr, 2004, 16(1): 51-57.
2.	Hinton RY, Lincoln A, Crockett MM, et al. Fractures of the femoral shaft in children. Incidence, mechanisms, and sociodemographic risk factors. J Bone Joint Surg (Am), 1999, 81(4): 500-509.
3.	Flynn JM, Schwend RM. Management of pediatric femoral shaft fractures. J Am Acad Orthop Surg, 2004, 12(5): 347-359.
4.	Flynn JM, Luedtke L, Ganley TJ, et al. Titanium elastic nails for pediatric femur fractures: Lessons from the learning curve. Am J Orthop, 2002, 31(2): 71-74.
5.	Narayanan UG, Hyman JE, Wainwright AM, et al. Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them. J Pediatr Orthop, 2004, 24(4): 363-369.
6.	Kempf I, Grosse A, Beck G. Closed locked intramedullary nailing. Its application to comminuted fractures of the femur. J Bone Joint Surg (Am), 1985, 67(5): 709-720.
7.	Winquist RA, Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg (Am), 1984, 66(4): 529-539.
8.	Beaty JH, Austin SM, Warner WC, et al. Interlocking intramedullary nailing of femoral-shaft fractures in adolescents: preliminary results and complications. J Pediatr Orthop, 1994, 14(2): 178-183.
9.	Buford D Jr, Christensen K, Weatherall P. Intramedullary nailing of femoral fractures in adolescents. Clin Orthop Relat Res, 1998, (350): 85-89.
10.	Herndon WA, Mahnken RF, Yngve DA, et al. Management of femoral shaft fractures in the adolescent. J Pediatr Orthop, 1989, 9(1): 29-32.
11.	Ziv I, Blackburn N, Rang M. Femoral intramedullary nailing in the growing child. J Trauma, 1984, 24(5): 432-434.
12.	Timmerman LA, Rab GT. Intramedullary nailing of femoral shaft fractures in adolescents. J Orthop Trauma, 1993, 7(4): 331-337.
13.	Kocher MS. American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of pediatric diaphyseal femur fracture. J Bone Joint Surg (Am), 2010, 92(8): 1790-1792.
14.	Moroz LA. Titanium elastic nailing of fractures of the femur in children. Predictors of complications and poor outcome. J Bone Joint Surg (Br), 2006, 88(10): 1361-1366.
15.	Leet AI, Pichard CP, Ain MC. Surgical treatment of femoral fractures in obese children: does excessive body weight increase the rate of complications? J Bone Joint Surg (Am), 2005, 87(12): 2609-2613.
16.	Mileski RA, Garvin KL, Crosby LA. Avascular necrosis of the femoral head in an adolescent following intramedullary nailing of the femur. A case report. J Bone Joint Surg (Am), 1994, 76(11): 1706-1708.
17.	Mileski RA, Garvin KL, Huurman WW. Avascular necrosis of the femoral head after closed intramedullary shortening in an adolescent. J Pediatr Orthop, 1995, 15(1): 24-26.
18.	O’Malley DE, Mazur JM, Cummings RJ. Femoral head avascular necrosis associated with intramedullary nailing in an adolescent. J Pediatr Orthop, 1995, 15(1): 21-23.
19.	Chung SMK. The arterial supply of the developing proximal end of the femur. J Bone Joint Surg (Am), 1976, 58(7): 961-970.
20.	Ogden JA. Changing patterns of proximal femoral vascularity. J Bone Joint Surg (Am), 1974, 56(5): 941-950.
21.	Beebe KS, Sabharwal S, Behrens F. Femoral shaft fractures: is rigid intramedullary nailing safe for adolescents? Am J Orthop (Belle Mead NJ), 2006, 35(4): 172-174.
22.	Townsend DR, Hoffinger S. Intramedullary nailing of femoral shaft fractures in children via the trochanter tip. Clin Orthop, 2000, (376): 113-118.
23.	Gordon JE, Swenning TA, Burd TA, et al. Proximal femoral radiographic changes after lateral transtrochanteric intramedullary nail placement in children. J Bone Joint Surg (Am), 2003, 85-A(7): 1295-1301.
24.	Gonzalez-Herranz P, Burgos-Flores J, Rapariz JM, et al. Intramedullary nailing of the femur in children. Effects on its proximal end. J Bone Joint Surg (Br), 1995, 77(2): 262-266.
25.	Raney EM, Ogden JA, Grogan DP. Premature greater trochanteric epiphysiodesis secondary to intramedullary femoral rodding. J Pediatr Orthop, 1993, 13(4): 516-520.
26.	Gonzalez-Herranz P, Burgos-Flores J, Rapariz JM, et al. Intramedullary nailing of the femur in children. Effects on its proximal end. J Bone Joint Surg (Br), 1995, 77(2): 262-266.
27.	Raney EM, Ogden JA, Grogan DP. Premature greater trochanteric epiphysiodesis secondary to intramedullary femoral rodding. J Pediatr Orthop, 1993, 13(4): 516-520.
28.	Hosalkar HS. Intramedullary nailing of pediatric femoral shaft fracture. J Am Acad Orthop Surg, 2011, 19(8): 472-481.
29.	Luhmann SJ, Schootman M, Schoenecker PL, et al. Complications of titanium elastic nails for pediatric femoral shaft fractures. J Pediatr Orthop, 2003, 23(4): 443-447.
30.	Bhatt T, Mehlman DO, Foad SL, et al. Weight greater than or equal to 99 pounds and age greater than or equal to 12 years predict malunion following elastic stable intramedullary nailing of femoral shaft fractures in children. TA 20th Annual Meeting Paper, 2004.
31.	Townsend DR, Hoffinger S. Intramedullary nailing of femoral shaft fractures in children via the trochanter tip. Clin Orthop Relat Res, 2000, (376): 113-118.
32.	Park H, Kim HW. Treatment of femoral shaft fracture with an interlocking humeral nail in older children and adolescents.Yonsei Med J, 2012, 53(2): 408-415.

1. Gardner MJ, Lawrence BD, Griffith MH. Surgical treatment of pediatric femoral shaft fractures. Curr Opin Pediatr, 2004, 16(1): 51-57.
2. Hinton RY, Lincoln A, Crockett MM, et al. Fractures of the femoral shaft in children. Incidence, mechanisms, and sociodemographic risk factors. J Bone Joint Surg (Am), 1999, 81(4): 500-509.
3. Flynn JM, Schwend RM. Management of pediatric femoral shaft fractures. J Am Acad Orthop Surg, 2004, 12(5): 347-359.
4. Flynn JM, Luedtke L, Ganley TJ, et al. Titanium elastic nails for pediatric femur fractures: Lessons from the learning curve. Am J Orthop, 2002, 31(2): 71-74.
5. Narayanan UG, Hyman JE, Wainwright AM, et al. Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them. J Pediatr Orthop, 2004, 24(4): 363-369.
6. Kempf I, Grosse A, Beck G. Closed locked intramedullary nailing. Its application to comminuted fractures of the femur. J Bone Joint Surg (Am), 1985, 67(5): 709-720.
7. Winquist RA, Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg (Am), 1984, 66(4): 529-539.
8. Beaty JH, Austin SM, Warner WC, et al. Interlocking intramedullary nailing of femoral-shaft fractures in adolescents: preliminary results and complications. J Pediatr Orthop, 1994, 14(2): 178-183.
9. Buford D Jr, Christensen K, Weatherall P. Intramedullary nailing of femoral fractures in adolescents. Clin Orthop Relat Res, 1998, (350): 85-89.
10. Herndon WA, Mahnken RF, Yngve DA, et al. Management of femoral shaft fractures in the adolescent. J Pediatr Orthop, 1989, 9(1): 29-32.
11. Ziv I, Blackburn N, Rang M. Femoral intramedullary nailing in the growing child. J Trauma, 1984, 24(5): 432-434.
12. Timmerman LA, Rab GT. Intramedullary nailing of femoral shaft fractures in adolescents. J Orthop Trauma, 1993, 7(4): 331-337.
13. Kocher MS. American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of pediatric diaphyseal femur fracture. J Bone Joint Surg (Am), 2010, 92(8): 1790-1792.
14. Moroz LA. Titanium elastic nailing of fractures of the femur in children. Predictors of complications and poor outcome. J Bone Joint Surg (Br), 2006, 88(10): 1361-1366.
15. Leet AI, Pichard CP, Ain MC. Surgical treatment of femoral fractures in obese children: does excessive body weight increase the rate of complications? J Bone Joint Surg (Am), 2005, 87(12): 2609-2613.
16. Mileski RA, Garvin KL, Crosby LA. Avascular necrosis of the femoral head in an adolescent following intramedullary nailing of the femur. A case report. J Bone Joint Surg (Am), 1994, 76(11): 1706-1708.
17. Mileski RA, Garvin KL, Huurman WW. Avascular necrosis of the femoral head after closed intramedullary shortening in an adolescent. J Pediatr Orthop, 1995, 15(1): 24-26.
18. O’Malley DE, Mazur JM, Cummings RJ. Femoral head avascular necrosis associated with intramedullary nailing in an adolescent. J Pediatr Orthop, 1995, 15(1): 21-23.
19. Chung SMK. The arterial supply of the developing proximal end of the femur. J Bone Joint Surg (Am), 1976, 58(7): 961-970.
20. Ogden JA. Changing patterns of proximal femoral vascularity. J Bone Joint Surg (Am), 1974, 56(5): 941-950.
21. Beebe KS, Sabharwal S, Behrens F. Femoral shaft fractures: is rigid intramedullary nailing safe for adolescents? Am J Orthop (Belle Mead NJ), 2006, 35(4): 172-174.
22. Townsend DR, Hoffinger S. Intramedullary nailing of femoral shaft fractures in children via the trochanter tip. Clin Orthop, 2000, (376): 113-118.
23. Gordon JE, Swenning TA, Burd TA, et al. Proximal femoral radiographic changes after lateral transtrochanteric intramedullary nail placement in children. J Bone Joint Surg (Am), 2003, 85-A(7): 1295-1301.
24. Gonzalez-Herranz P, Burgos-Flores J, Rapariz JM, et al. Intramedullary nailing of the femur in children. Effects on its proximal end. J Bone Joint Surg (Br), 1995, 77(2): 262-266.
25. Raney EM, Ogden JA, Grogan DP. Premature greater trochanteric epiphysiodesis secondary to intramedullary femoral rodding. J Pediatr Orthop, 1993, 13(4): 516-520.
26. Gonzalez-Herranz P, Burgos-Flores J, Rapariz JM, et al. Intramedullary nailing of the femur in children. Effects on its proximal end. J Bone Joint Surg (Br), 1995, 77(2): 262-266.
27. Raney EM, Ogden JA, Grogan DP. Premature greater trochanteric epiphysiodesis secondary to intramedullary femoral rodding. J Pediatr Orthop, 1993, 13(4): 516-520.
28. Hosalkar HS. Intramedullary nailing of pediatric femoral shaft fracture. J Am Acad Orthop Surg, 2011, 19(8): 472-481.
29. Luhmann SJ, Schootman M, Schoenecker PL, et al. Complications of titanium elastic nails for pediatric femoral shaft fractures. J Pediatr Orthop, 2003, 23(4): 443-447.
30. Bhatt T, Mehlman DO, Foad SL, et al. Weight greater than or equal to 99 pounds and age greater than or equal to 12 years predict malunion following elastic stable intramedullary nailing of femoral shaft fractures in children. TA 20th Annual Meeting Paper, 2004.
31. Townsend DR, Hoffinger S. Intramedullary nailing of femoral shaft fractures in children via the trochanter tip. Clin Orthop Relat Res, 2000, (376): 113-118.
32. Park H, Kim HW. Treatment of femoral shaft fracture with an interlocking humeral nail in older children and adolescents.Yonsei Med J, 2012, 53(2): 408-415.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of rigid interlocking nails through tip of greater trochanter for fixation of femur shaft fracture in adolescent

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