Intramedullary nailing of femoral shaft fractures in children via the trochanter tip.

Closed rigid intramedullary nailing of femoral shaft fractures in children has been associated with avascular necrosis of the femoral head. Avascular necrosis of the femoral head is thought to result from damage to the medial femoral circumflex artery by placing the nail through the piriformis fossa. The authors describe the early results of a technique in which the nail is placed through the tip of the greater trochanter, thus avoiding the piriformis fossa and possible damage to the medial circumflex artery. Between 1988 and 1995, the authors performed this procedure on 34 patients, who ranged in age from 10 years 2 months to 17 years 6 months. Followup time ranged from 1 month to 120 months. There were no infections, nonunions, rotational deformities, or implant failures. Twenty patients with open physes had a followup of 2 years or more. To date, no patient had avascular necrosis of the femoral head develop. The trochanteric tip entry point is recommended for closed rigid intramedullary nailing of femoral shaft fractures in children and adolescents.