Short-term effectiveness of expert adolescent lateral femoral nail fixation for femoral shaft fractures in older children and adolescents_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 HE Xiaozhang ¹ , WANG Tao ¹ , NAN Guoxin ² , WANG Jundong ¹ , LIAO Peng ¹ , XU Shaolin ¹ , YU Kailong ¹

1. Department of Pediatric Surgery, Pingxiang People’s Hospital, Pingxiang Jiangxi, 337000, P. R. China;
2. Department of Pediatric Orthopedics, Municipal Children’s Hospital, Guangdong Medical University, Dongguan Guangdong, 523326, P. R. China;

Corresponding?author：

HE Xiaozhang, Email: wellsmile@163.com

Keywords：

Femoral shaft fracture; expert adolescent lateral femoral nail; intramedullary central fixation; older children; adolescents

DOI：

10.7507/1002-1892.202412087

Video：

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Objective To investigate short-term effectiveness of using expert adolescent lateral femoral nail (EALFN) in treating femoral shaft fractures in older children and adolescents. Methods A retrospective analysis was conducted on the clinical data of 17 patients with femoral shaft fractures who met the inclusion criteria and were admitted between July 2020 and June 2024. All fractures were fixed with EALFN after reduction. There were 11 males and 6 females, with a mean age of 13.3 years (range, 11-16 years). The average body weight was 51.2 kg (range, 40-84 kg), and the average height was 162.1 cm (range, 150-172 cm). The causes of injury included traffic accidents (n=9), falling from height (n=1), and simple falls (n=7). One patient had an open fracture treated with an external fixator and experienced delayed fracture healing. The remaining patients were closed fractures, with an average time from injury to operation of 5.8 days (range, 2-10 days). Operation time and postoperative hospital stay were documented. During follow-up, X-ray films were taken to observe the fracture healing, and the bilateral femoral length, femoral neck-shaft angle, widest femoral neck diameter (FND), and articular trochanteric distance (ATD) were measured at last follow-up. Hip function was assessed using the Harris score. The differences in the all indicators between the healthy and affected sides were compared. Results The operation time ranged from 65 to 130 minutes (mean, 94.1 minutes). Postoperative hospital stay ranged from 5 to 40 days (mean, 16.7 days). All patients were followed up 7-36 months (mean, 14.4 months). One patient exhibited delayed fracture healing during follow-up. The distal locking nail was removed at 6 months after operation, and partial weight-bearing was initiated following dynamic fracture stabilization. The fracture healing was achieved, and the intramedullary nail was removed at 24 months after operation. The other fractures healed with the healing time of 6-20 months (mean, 9.6 months), and the intramedullary nails were removed. During follow-up, no femoral fracture, abnormal development of the greater trochanter, or ischemic necrosis of the femoral head occurred. At last follow-up, there was no significant difference in femoral length, femoral neck-shaft angle, FND, ATD, or Harris score between the affected and healthy sides (P>0.05). Conclusion For older children and adolescents with femoral neck fractures, the application of EALFN fixation aligns more closely with the principles of intramedullary central fixation and rapid rehabilitation. This approach is associated with fewer complications and superior short-term effectiveness.

Citation： HE Xiaozhang, WANG Tao, NAN Guoxin, WANG Jundong, LIAO Peng, XU Shaolin, YU Kailong. Short-term effectiveness of expert adolescent lateral femoral nail fixation for femoral shaft fractures in older children and adolescents. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(3): 290-295. doi: 10.7507/1002-1892.202412087 Copy

1.	Salonen A, Laitakari E, Berg HE, et al. Incidence of femoral fractures in children and adolescents in Finland and Sweden between 1998 and 2016: A binational population-based study. Scand J Surg, 2022, 111(1): 14574969221083133. doi: 10.1177/14574969221083133.
2.	孫超, 劉萬林, 韋宜山, 等. 應用彈性髓內針與髖部鎖定加壓鋼板治療兒童股骨轉子下骨折手術潛在風險因素的對比研究. 臨床小兒外科雜志, 2020, 19(7): 565-572.
3.	Loder RT, O’Donnell PW, Feinberg JR. Epidemiology and mechanisms of femur fractures in children. J Pediatr Orthop, 2006, 26(5): 561-566.
4.	孫川, 吳永濤, 李敏, 等. 彈性髓內釘固定治療5~14歲兒童股骨干骨折. 美中國際創傷雜志, 2016, 15(1): 19-21.
5.	張立軍. 兒童股骨干骨折的規范化治療. 中國骨與關節雜志, 2015, 4(10): 766-770.
6.	張磊, 左玉明, 王月光, 等. 大粗隆頂點開口順行帶鎖髓內釘治療青少年股骨干骨折療效觀察. 中國修復重建外科雜志, 2017, 31(3): 262-265.
7.	盧育南, 林然, 潘諾琪, 等. Bouquet技術治療兒童不穩定型股骨干骨折的療效分析. 中華創傷骨科雜志, 2022, 24(12): 1042-1048.
8.	王宣, 劉玉昌, 韓久卉, 等. 外固定架輔助彈性髓內釘治療兒童四肢干部骨折. 中國矯形外科雜志, 2021, 29(16): 1530-1532.
9.	孫亮, 白銳, 劉萬林, 等. 閉合復位剛性髓內釘治療大齡、高體重兒童及青少年股骨干骨折. 實用骨科雜志, 2020, 26(10): 873-876.
10.	陳偉, 李佳, 張英澤. AAOS《兒童股骨干骨折治療指南》解讀. 中華外科雜志, 2017, 55(1): 44-48.
11.	謝康, 李陽, 張亞鵬, 等. 青少年型鎖定髓內釘治療兒童股骨干骨折的療效. 臨床骨科雜志, 2021, 24(1): 116-118.
12.	Hammouda AI, Jauregui JJ, Gesheff MG, et al. Trochanteric entry for femoral lengthening nails in children: Is it safe? J Pediatr Orthop, 2017, 37(4): 258-264.
13.	黃佳平, 陳志達, 丁真奇, 等. 交鎖髓內釘聯合與不聯合阻擋螺釘內固定治療老年股骨干骨折的療效比較. 中國骨與關節損傷雜志, 2022, 37(2): 186-188.
14.	徐峰, 袁凱旋, 陳圣寶, 等. 髖關節功能評分研究進展. 國際骨科學雜志, 2018, 39(3): 141-144.
15.	González-Herranz P, Burgos-Flores J, Rapariz JM, et al. Intramedullary nailing of the femur in children. Effects on its proximal end. J Bone Joint Surg (Br), 1995, 77(2): 262-266.
16.	Knapik DM, McCarthy C, Liu RW. Developmental patterns of the greater trochanter in skeletally immature patients. J Pediatr Orthop, 2019, 39(6): e412-e416.
17.	Megas P, Syggelos SA, Kontakis G, et al. Intramedullary nailing for the treatment of aseptic femoral shaft non-unions after plating failure: effectiveness and timing. Injury, 2009, 40(7): 732-737.
18.	陸定松, 李永剛, 楊志奎, 等. 切開復位交鎖髓內釘內固定與閉合復位交鎖髓內釘內固定治療老年股骨干骨折的效果比較. 臨床醫學研究與實踐, 2022, 7(1): 82-85.
19.	張偉, 李建濤, 聶少波, 等. 多維交叉鎖定接骨板治療股骨干髓內釘術后骨不連的臨床療效研究. 中華骨與關節外科雜志, 2021, 14(4): 292-297.
20.	張恒, 李文銳. 影響骨折愈合的因素——應力和微動. 海南醫學, 2010, 21(1): 112-116.
21.	邢丹, 馬信龍, 宋東輝, 等. 長骨骨折愈合力學環境的研究現狀. 生物醫學工程與臨床, 2012, 16(6): 602-606.
22.	王磊, 李佳, 李濤, 等. 青少年型髓內釘治療大齡兒童股骨干骨折的近期療效隨訪. 中國骨與關節雜志, 2022, 11(12): 935-938.
23.	Miner T, Carroll KL. Outcomes of external fixation of pediatric femoral shaft fractures. J Pediatr Orthop, 2000, 20(3): 405-410.
24.	Moroz LA, Launay F, Kocher MS, et al. Titanium elastic nailing of fractures of the femur in children. Predictors of complications and poor outcome. J Bone Joint Surg (Br), 2006, 88(10): 1361-1366.
25.	劉朝宇, 張建強, 徐文強, 等. 側臥位斯氏針搖桿技術輔助復位髓內釘固定治療青少年股骨骨折. 臨床小兒外科雜志, 2024, 23(2): 162-167.
26.	馬洪, 沈釗雄, 郭躍明. 髓內釘固定治療青少年股骨干骨折的療效分析. 中華創傷骨科雜志, 2021, 23(3): 262-266.

1. Salonen A, Laitakari E, Berg HE, et al. Incidence of femoral fractures in children and adolescents in Finland and Sweden between 1998 and 2016: A binational population-based study. Scand J Surg, 2022, 111(1): 14574969221083133. doi: 10.1177/14574969221083133.
2. 孫超, 劉萬林, 韋宜山, 等. 應用彈性髓內針與髖部鎖定加壓鋼板治療兒童股骨轉子下骨折手術潛在風險因素的對比研究. 臨床小兒外科雜志, 2020, 19(7): 565-572.
3. Loder RT, O’Donnell PW, Feinberg JR. Epidemiology and mechanisms of femur fractures in children. J Pediatr Orthop, 2006, 26(5): 561-566.
4. 孫川, 吳永濤, 李敏, 等. 彈性髓內釘固定治療5~14歲兒童股骨干骨折. 美中國際創傷雜志, 2016, 15(1): 19-21.
5. 張立軍. 兒童股骨干骨折的規范化治療. 中國骨與關節雜志, 2015, 4(10): 766-770.
6. 張磊, 左玉明, 王月光, 等. 大粗隆頂點開口順行帶鎖髓內釘治療青少年股骨干骨折療效觀察. 中國修復重建外科雜志, 2017, 31(3): 262-265.
7. 盧育南, 林然, 潘諾琪, 等. Bouquet技術治療兒童不穩定型股骨干骨折的療效分析. 中華創傷骨科雜志, 2022, 24(12): 1042-1048.
8. 王宣, 劉玉昌, 韓久卉, 等. 外固定架輔助彈性髓內釘治療兒童四肢干部骨折. 中國矯形外科雜志, 2021, 29(16): 1530-1532.
9. 孫亮, 白銳, 劉萬林, 等. 閉合復位剛性髓內釘治療大齡、高體重兒童及青少年股骨干骨折. 實用骨科雜志, 2020, 26(10): 873-876.
10. 陳偉, 李佳, 張英澤. AAOS《兒童股骨干骨折治療指南》解讀. 中華外科雜志, 2017, 55(1): 44-48.
11. 謝康, 李陽, 張亞鵬, 等. 青少年型鎖定髓內釘治療兒童股骨干骨折的療效. 臨床骨科雜志, 2021, 24(1): 116-118.
12. Hammouda AI, Jauregui JJ, Gesheff MG, et al. Trochanteric entry for femoral lengthening nails in children: Is it safe? J Pediatr Orthop, 2017, 37(4): 258-264.
13. 黃佳平, 陳志達, 丁真奇, 等. 交鎖髓內釘聯合與不聯合阻擋螺釘內固定治療老年股骨干骨折的療效比較. 中國骨與關節損傷雜志, 2022, 37(2): 186-188.
14. 徐峰, 袁凱旋, 陳圣寶, 等. 髖關節功能評分研究進展. 國際骨科學雜志, 2018, 39(3): 141-144.
15. González-Herranz P, Burgos-Flores J, Rapariz JM, et al. Intramedullary nailing of the femur in children. Effects on its proximal end. J Bone Joint Surg (Br), 1995, 77(2): 262-266.
16. Knapik DM, McCarthy C, Liu RW. Developmental patterns of the greater trochanter in skeletally immature patients. J Pediatr Orthop, 2019, 39(6): e412-e416.
17. Megas P, Syggelos SA, Kontakis G, et al. Intramedullary nailing for the treatment of aseptic femoral shaft non-unions after plating failure: effectiveness and timing. Injury, 2009, 40(7): 732-737.
18. 陸定松, 李永剛, 楊志奎, 等. 切開復位交鎖髓內釘內固定與閉合復位交鎖髓內釘內固定治療老年股骨干骨折的效果比較. 臨床醫學研究與實踐, 2022, 7(1): 82-85.
19. 張偉, 李建濤, 聶少波, 等. 多維交叉鎖定接骨板治療股骨干髓內釘術后骨不連的臨床療效研究. 中華骨與關節外科雜志, 2021, 14(4): 292-297.
20. 張恒, 李文銳. 影響骨折愈合的因素——應力和微動. 海南醫學, 2010, 21(1): 112-116.
21. 邢丹, 馬信龍, 宋東輝, 等. 長骨骨折愈合力學環境的研究現狀. 生物醫學工程與臨床, 2012, 16(6): 602-606.
22. 王磊, 李佳, 李濤, 等. 青少年型髓內釘治療大齡兒童股骨干骨折的近期療效隨訪. 中國骨與關節雜志, 2022, 11(12): 935-938.
23. Miner T, Carroll KL. Outcomes of external fixation of pediatric femoral shaft fractures. J Pediatr Orthop, 2000, 20(3): 405-410.
24. Moroz LA, Launay F, Kocher MS, et al. Titanium elastic nailing of fractures of the femur in children. Predictors of complications and poor outcome. J Bone Joint Surg (Br), 2006, 88(10): 1361-1366.
25. 劉朝宇, 張建強, 徐文強, 等. 側臥位斯氏針搖桿技術輔助復位髓內釘固定治療青少年股骨骨折. 臨床小兒外科雜志, 2024, 23(2): 162-167.
26. 馬洪, 沈釗雄, 郭躍明. 髓內釘固定治療青少年股骨干骨折的療效分析. 中華創傷骨科雜志, 2021, 23(3): 262-266.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of expert adolescent lateral femoral nail fixation for femoral shaft fractures in older children and adolescents

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