Femoral shaft fractures: is rigid intramedullary nailing safe for adolescents?

Despite recent reports of avascular necrosis of the femoral head after intramedullary nailing in children, this fixation method is still being advocated for the treatment of femoral shaft fractures. In this article, we report a case of early-onset, severe, symptomatic avascular necrosis of the femoral head after intramedullary nailing in a 13-year-old boy. Given the possibility of this devastating complication, surgeons should consider the risk-benefit ratios of various techniques for managing femoral shaft fractures in adolescents.