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Treating Pediatric Subtrochanteric Femur Fractures with a Statically Locked Intramedullary Nail: A Review of 17 Cases

Sunday, October 21, 2012: 8:42 AM
Melrose (Hilton Riverside)
Robert Meuret1, Jonathan H. Phillips2 and Jose A. Herrera-Soto2, (1)Orthopedics, Arnold Palmer Hospital for Children, Orlando, FL, (2)Pediatric Orthopaedics, Orlando Health, Orlando, FL

Purpose

Subtrochanteric femur fractures in children are relatively uncommon.  Several different methods of treatment have been used with good results, including traction and casting, external fixation, open reduction and plate fixation, flexible intramedullary nailing and cast bracing.  All of these have certain limitations and potential complications. The purpose of our study was to present intramedullary locking nail fixation for children with subtrochanteric femur fractures. 

Methods

Between 2005 and 2011 we reviewed retrospectively all operative cases at our institution fixed with the intramedullary locking nail.  Follow-up visits data was collected on when full weight bearing was started, return to full activity, residual pain, gait abnormality and alignment or any other complication.

Results

The average age was 11.7 years old (range, 9 to 15 y/o).  There were 14 males and 3 female patients with an average BMI of 19.2.  The average operating time was 79 minutes.  There were no intraoperative complications recorded.  The average length of the hospital stay was 2.4 days, excluding the multiple body injured patient.  Weight bearing was begun on average 23.6 days from surgery (range, 13-37 days).  Full weight bearing was initiated at 66.4 days on average (range, 45-164 days).  Thirteen of the patients had the implants removed at an average of 9 months.  No patients were noted to have leg length discrepancies or rotational misalignments of the affected limb or coxa valga.  There was no refracture, nonunion or malunion and no cases of avascular necrosis of the femoral head.  Thigh pain was seen in two patients that resolved spontaneously. 

Conclusion

External fixation, flexible nailing, traction and plating have exhibited problems including malunion, over growth of the femur, infections and refracture.  The locked nail controls rotation and prevents shortening while maintaining the alignment of the fracture.  An added benefit of the PLN is a load-sharing device and therefore, it allows quicker return to full weight bearing and absence of post-operative immobilization.   We believe that the limp and thigh pain can be related to the healing fracture and disuse of the affected extremity until the patient was full weight bearing without assistive devices.  When comparing the treatment of subtrochanteric femur fractures in children 8 years of age and older it can be concluded that the use of a locking nail is as good as or better of a treatment than other methods.