title: Twenty-Year Experience with Rigid Intramedullary Nailing of Femoral Shaft Fractures in Skeletally Immature Patients.
abstract: BACKGROUND
  Debate exists over the safety of rigid intramedullary nailing of femoral shaft fractures in skeletally immature patients. The goal of this study was to describe functional outcomes and complication rates of rigid intramedullary nailing in pediatric patients.
  
  
  METHODS
  A retrospective review was performed of femoral shaft fractures in skeletally immature patients treated with trochanteric rigid intramedullary nailing from 1987 to 2009. Radiographs made at initial injury, immediately postoperatively, and at the latest follow-up were reviewed. Patients were administered the Nonarthritic Hip Score and a survey.
  
  
  RESULTS
  The study population of 241 patients with 246 fractures was primarily male (75%) with a mean age of 12.9 years (range, eight to seventeen years). The majority of fractures were closed (92%) and associated injuries were common (45%). The mean operative time was 119 minutes, and the mean estimated blood loss was 202 mL. The mean clinical follow-up time was 16.2 months (range, three to seventy-nine months), and there were ninety-three patients with a minimum two-year clinical and radiographic follow-up. An increase of articulotrochanteric distance of >5 mm was noted in 15.1% (fourteen of ninety-three patients) at a minimum two-year follow-up; however, clinically relevant growth disturbance was only observed in two patients (2.2%) with the development of asymptomatic coxa valga. There was no femoral head osteonecrosis. Among the 246 fractures, twenty-four complications (9.8%) occurred. At the time of the latest follow-up, 1.7% (four of 241 patients) reported pain. The average Nonarthritic Hip Score was 92.4 points (range, 51 to 100 points), and 100% of patients reported satisfaction with their treatment.
  
  
  CONCLUSIONS
  Rigid intramedullary nailing is an effective technique for treatment of femoral shaft fractures in pediatric patients with an acceptable rate of complications.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, 4202 DOT, 2200 Children's Way, Nashville, TN 37232-9565. E-mail address for J.E. Martus: jeff.martus@vanderbilt.edu.
authors.forename: Samuel N
authors.initials: SN
authors.lastname: Crosby
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, 4202 DOT, 2200 Children's Way, Nashville, TN 37232-9565. E-mail address for J.E. Martus: jeff.martus@vanderbilt.edu.
authors.forename: Elliott J
authors.initials: EJ
authors.lastname: Kim
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Koehler
authors.affiliation: Beacon Orthopedics and Sports Medicine, 500 E-business Way, Sharonville, OH 45241.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Rohmiller
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, 4202 DOT, 2200 Children's Way, Nashville, TN 37232-9565. E-mail address for J.E. Martus: jeff.martus@vanderbilt.edu.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Mencio
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, 4202 DOT, 2200 Children's Way, Nashville, TN 37232-9565. E-mail address for J.E. Martus: jeff.martus@vanderbilt.edu.
authors.forename: Neil E
authors.initials: NE
authors.lastname: Green
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, 4202 DOT, 2200 Children's Way, Nashville, TN 37232-9565. E-mail address for J.E. Martus: jeff.martus@vanderbilt.edu.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Lovejoy
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, 4202 DOT, 2200 Children's Way, Nashville, TN 37232-9565. E-mail address for J.E. Martus: jeff.martus@vanderbilt.edu.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Schoenecker
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, 4202 DOT, 2200 Children's Way, Nashville, TN 37232-9565. E-mail address for J.E. Martus: jeff.martus@vanderbilt.edu.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Martus
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome