Effectiveness of rigid interlocking nails through tip of greater trochanter for fixation of femur shaft fracture in adolescent

Abstract

To explore the effectiveness of rigid interlocking nails through the tip of the greater trochanter for fixation of femur shaft fracture in adolescent. A retrospective analysis was made on the clinical data of 23 adolescents with femoral shaft fractures treated between June 2011 and June 2015. Of 23 cases, 19 were male and 4 were female, aged from 13 years and 6 months to 17 years (mean, 15.2 years), weighed from 40 to 77 kg (mean, 53.5 kg). The causes were traffic accident injury in 13 cases, sports injury in 7 cases, and falling injury in 3 cases. Fracture located at the proximal 1/3 in 6 cases, middle 1/3 in 10 cases, and distal 1/3 in 7 cases; fracture was typed as transverse in 10 cases, oblique in 6 cases, spiral in 1 case, and comminuted in 6 cases. The course of disease was 3-17 days (mean, 6.2 days). At last follow-up, the leg length discrepancy, femoral neck shaft angle, femoral neck diameter, and articulotrochanteric distance (ATD) were measured on the X-ray films. Wounds healed in all patients, and no infection occurred. All patients were followed up 15-36 months (mean, 26.5 months). The patients had no pain and had normal gait, without lameness. The X-ray films showed bone healing at 5-13 months (mean, 6.5 months). No nonunion, delayed union, malunion of more than 5 °, or rotational deformity occurred. The removal time of internal fixations was 12-24 months (mean, 19.5 months) after operation. No heterotopic ossification, re-fracture, proximal femoral deformity, or femoral head necrosis occurred during follow-up. Two patients had early epiphyseal closure of greater trochanter, which had no impact on gait; leg-length inequality of less than 1 cm was observed in 2 cases. At last follow-up, the neck shaft angle, femoral neck diameter, and ATD of normal and affected sides were (131.7±6.3) and (132.9±7.8)°, (34.1±3.2) and (33.9±3.8) mm, and (27.8±9.2) and (26.5±8.5) mm, showing no significant difference between two sides ( t=-0.24, P=0.86; t=0.18, P=0.92; t=1.03, P=0.49). It is a reliable and effective method to use rigid interlocking nails inserted through the tip of the greater trochanter for the fixation of femur shaft fracture in adolescent.