Antegrade flexible intramedullary nailing through the greater trochanter in paediatric femur shaft fractures

Keywords paediatric, femur shaft fractures, flexible intramedullary nails, antegrade

Abstract

Aims: To determine whether an antegrade approach, through the tip of the greater trochanter, in femoral shaft fractures in children, is safe, achieves adequate union and results in significant proximal femoral growth complications.


Patients and methods: The case records and radiographs of 23 paediatric patients aged 7 to 12 years with femur shaft fractures managed with stainless steel antegrade flexible nailing were reviewed retrospectively. Pre-operative radiographs were reviewed for fracture pattern, level and comminution. Post-operative radiographs were reviewed to assess for union, alignment, osteonecrosis of the femoral head and epiphysiodesis of the greater trochanter. Morphological changes of the proximal femur were assessed by comparing the neck shaft angle and articulo-trochanteric distance with the opposite hip. Case records were reviewed for post-operative complications, patient-reported complaints and leg length discrepancy. Clinical outcomes were assessed with the criteria established by Flynn.


Results: All patients achieved union, and none had evidence of osteonecrosis of the femoral head on follow-up. Three patients had malalignment and two patients had radiographic evidence of greater trochanteric epiphysiodesis. Two patients had morphological changes of the proximal femur, with one having an increased neck shaft angle and one an increased articulo-trochanteric distance. One patient had a leg length discrepancy of 2 cm. Fifteen patients had excellent clinical outcomes, five had satisfactory outcomes and three had poor outcomes according the criteria established by Flynn.


Conclusion: Antegrade entry through the tip of the greater trochanter does not appear to compromise the blood supply to the femoral head or increase the risk of clinically significant morphological changes to the proximal femur. All patients achieved adequate union. Furthermore, antegrade insertion avoided skin problems and prominent nail complications around the knee seen with retrograde insertion.


Level of evidence: Level 4

Author Biographies

R C Rosin, University of KwaZulu-Natal

MBChB(UCT); Orthopaedic Registrar, Department of Orthopaedic Surgery, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, South Africa

M N Rasool, University of KwaZulu-Natal

MBCH, FCS(SA), PhD; Professor of Paediatric Orthopaedic Surgery, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal

W Sibanda, University of KwaZulu-Natal

PhD Statistics (North-West University); Biostatistics Unit, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

P D Rollinson, Ngwelezana Hospital

MBChB(Sheff), FRCS (Ed & Eng); Chief Orthopaedic Specialist, Ngwelezana Hospital, Empangeni, KwaZulu-Natal, South Africa

Published
2019-09-17
How to Cite
ROSIN, R C et al. Antegrade flexible intramedullary nailing through the greater trochanter in paediatric femur shaft fractures. South African Orthopaedic Journal, [S.l.], p. 20-27, sep. 2019. ISSN 2309-8309. Available at: <http://journal.saoa.org.za/index.php/saoj/article/view/320>. Date accessed: 14 dec. 2019.
Section
Paediatric Orthopaedics

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