Twenty-Year Experience with Rigid Intramedullary Nailing of Femoral Shaft Fractures in Skeletally Immature Patients

被引:33
作者
Crosby, Samuel N., Jr. [1 ]
Kim, Elliott J. [1 ]
Koehler, Daniel M. [1 ]
Rohmiller, Michael T. [1 ]
Mencio, Gregory A. [1 ]
Green, Neil E. [1 ]
Lovejoy, Steven A. [1 ]
Schoenecker, Jonathan G. [1 ]
Martus, Jeffrey E. [1 ]
机构
[1] Vanderbilt Univ, Dept Orthopaed Surg, Med Ctr, Monroe Carell Jr Childrens Hosp, Nashville, TN 37232 USA
关键词
AVASCULAR NECROSIS; GREATER TROCHANTER; INTERNAL-FIXATION; FOLLOW-UP; ADOLESCENT; CHILDREN; FEMUR; HEAD; COMPLICATIONS; EPIPHYSIS;
D O I
10.2106/JBJS.M.01128
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
100224 [整形外科学];
摘要
Background: Debate exists over the safety of rigid intramedullary nailing of femoral shaft fractures in skeletally immature patients. The goal of this study was to describe functional outcomes and complication rates of rigid intramedullary nailing in pediatric patients. Methods: A retrospective review was performed of femoral shaft fractures in skeletally immature patients treated with trochanteric rigid intramedullary nailing from 1987 to 2009. Radiographs made at initial injury, immediately postoperatively, and at the latest follow-up were reviewed. Patients were administered the Nonarthritic Hip Score and a survey. Results: The study population of 241 patients with 246 fractures was primarily male (75%) with a mean age of 12.9 years (range, eight to seventeen years). The majority of fractures were closed (92%) and associated injuries were common (45%). The mean operative time was 119 minutes, and the mean estimated blood loss was 202 mL. The mean clinical follow-up time was 16.2 months (range, three to seventy-nine months), and there were ninety-three patients with a minimum two-year clinical and radiographic follow-up. An increase of articulotrochanteric distance of >5 mm was noted in 15.1% (fourteen of ninety-three patients) at a minimum two-year follow-up; however, clinically relevant growth disturbance was only observed in two patients (2.2%) with the development of asymptomatic coxa valga. There was no femoral head osteonecrosis. Among the 246 fractures, twenty-four complications (9.8%) occurred. At the time of the latest follow-up, 1.7% (four of 241 patients) reported pain. The average Nonarthritic Hip Score was 92.4 points (range, 51 to 100 points), and 100% of patients reported satisfaction with their treatment. Conclusions: Rigid intramedullary nailing is an effective technique for treatment of femoral shaft fractures in pediatric patients with an acceptable rate of complications.
引用
收藏
页码:1080 / 1089
页数:10
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