WOFAPS 2025 8th World Congress of Pediatric Surgery

Feng Shan, Yunfang Zhen

Children's Hospital Affiliated to Soochow University

Background: To explore the efficacy of interlocking intramedullary nail in the treatment of femoral shaft fractures in adolescents.

Subjects and Methods: The clinical data of 10 adolescent femoral shaft fractures treated with interlocking intramedullary nailing in our hospital from January 2020 to December 2021 were retrospectively analyzed. Among the patients，8 were male and 2 were female. Their ages ranged from 11.5 to 15.3 years (mean, 12.8 years). Their weight ranged from 50.2kg to 70.2 kg (mean, 61.4 kg). The procedure was fixed with a static interlocking intramedullary nail. Periodic follow-up examinations were performed to monitor the occurrence of complications and to record the time of union of the fracture. At the last follow-up, neck shaft angle (NSA), medial proximal tibial angle (MPFA), femoral head diameter (FHD), femoral neck diameter (FND), and articulotrochanteric distance (ATD) were measured on the X-ray. Functional recovery of the affected limb was assessed using Thoresen’s criteria.

Result: The mean follow-up time was 14.4 months (10-17 months). All fractures healed, and all incisions healed at the first stage. No infection or incision dehiscence occurred. The average fracture union time was 5.1 weeks (4-8 weeks). The average radiological union time of the fracture was 9.6 weeks (6-12 weeks). There was no nonunion of the fracture,no delayed union, no malunion, no broken nails, no re-fracture. A leg length discrepancy of 1.4cm was observed in one case. One patient had ectopic ossification above the greater trochanter. Pressure ulcers occurred at the ankle in one patient. The NSA, MPFA, FHD, FND, and ATD at the final follow-up were, respectively, [(135.57±4.20)°、（91.86±6.39）°、（47.67±2.70）mm、（32.35±2.61）mm、（31.55±3.30）mm] for the affected side,which were insignificantly different from those for the healthy side [(136.42±6.92)°、（92.29±8.01）°、（47.34±2.79）mm、（32.29±2.27）mm、（29.66±2.42）mm] (P>0.05). According to the Thoresen criteria, there were 8 (80%) excellent, 1 (10%) good, and 1 (10%) satisfactory results with an excellent to good rate of 90%.

Conclusion: Interlocking intramedullary nailing is clinically effective in the treatment of femoral shaft fractures in adolescents, with excellent fracture union, few complications and no significant effects on proximal femur development in the short term.