Intramedullary nailing of femoral fractures in adolescents.

A prospective study of adolescents with femoral fractures treated with intramedullary nailing was done to identify complications and evaluate the outcome of this method of treatment. Sixty patients with femoral fractures have been treated with antegrade intramedullary nailing. Magnetic resonance imaging scans were obtained to evaluate for subclinical avascular necrosis of the femoral head. The average patient age was 12 years. All patients had open physes at the time of surgery. Implants were removed in 33 patients to date at an average of 10 months after initial nailing. All but two patients continue to have no signs of avascular necrosis, no rotational or angular deformity, and no nerve palsy. Two patients have had subclinical avascular necrosis as seen on magnetic resonance imaging. One patient had avascular necrosis develop in both femoral heads 1 year after nail removal from the right femur. The second patient has asymptomatic marrow changes on magnetic resonance imaging consistent with avascular necrosis with no femoral head collapse. It is thought that intramedullary nailing of pediatric femoral fractures is a safe treatment option. Few complications and a small risk of subclinical presentation of avascular necrosis of the femoral head that can become evident after removal of the implant have been found.