Twenty-year experience with rigid intramedullary nailing of femoral shaft fractures in skeletally immature patients

Samuel N. Crosby, Elliott J. Kim, Daniel M. Koehler, Michael T. Rohmiller, Gregory A. Mencio, Neil E. Green, Steven A. Lovejoy, Jonathan G. Schoenecker, Jeffrey E. Martus

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

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. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)1080-1089
Number of pages10
JournalJournal of Bone and Joint Surgery - American Volume
Volume96
Issue number13
DOIs
StatePublished - Jul 2 2014
Externally publishedYes

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Intramedullary Fracture Fixation
Femoral Fractures
Hip
Coxa Valga
Pediatrics
Closed Fractures
Osteonecrosis
Wounds and Injuries
Operative Time
Thigh
Patient Satisfaction
Therapeutics
Safety

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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Twenty-year experience with rigid intramedullary nailing of femoral shaft fractures in skeletally immature patients. / Crosby, Samuel N.; Kim, Elliott J.; Koehler, Daniel M.; Rohmiller, Michael T.; Mencio, Gregory A.; Green, Neil E.; Lovejoy, Steven A.; Schoenecker, Jonathan G.; Martus, Jeffrey E.

In: Journal of Bone and Joint Surgery - American Volume, Vol. 96, No. 13, 02.07.2014, p. 1080-1089.

Research output: Contribution to journalArticle

Crosby, SN, Kim, EJ, Koehler, DM, Rohmiller, MT, Mencio, GA, Green, NE, Lovejoy, SA, Schoenecker, JG & Martus, JE 2014, 'Twenty-year experience with rigid intramedullary nailing of femoral shaft fractures in skeletally immature patients', Journal of Bone and Joint Surgery - American Volume, vol. 96, no. 13, pp. 1080-1089. https://doi.org/10.2106/JBJS.M.01128
Crosby, Samuel N. ; Kim, Elliott J. ; Koehler, Daniel M. ; Rohmiller, Michael T. ; Mencio, Gregory A. ; Green, Neil E. ; Lovejoy, Steven A. ; Schoenecker, Jonathan G. ; Martus, Jeffrey E. / Twenty-year experience with rigid intramedullary nailing of femoral shaft fractures in skeletally immature patients. In: Journal of Bone and Joint Surgery - American Volume. 2014 ; Vol. 96, No. 13. pp. 1080-1089.
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abstract = "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. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.",
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AU - Crosby, Samuel N.

AU - Kim, Elliott J.

AU - Koehler, Daniel M.

AU - Rohmiller, Michael T.

AU - Mencio, Gregory A.

AU - Green, Neil E.

AU - Lovejoy, Steven A.

AU - Schoenecker, Jonathan G.

AU - Martus, Jeffrey E.

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N2 - 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. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

AB - 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. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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