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.	孙超, 刘万林, 韦宜山, 等. 应用弹性髓内针与髋部锁定加压钢板治疗儿童股骨转子下骨折手术潜在风险因素的对比研究. 临床小儿外科杂志, 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.	孙川, 吴永涛, 李敏, 等. 弹性髓内钉固定治疗5~14岁儿童股骨干骨折. 美中国际创伤杂志, 2016, 15(1): 19-21.
5.	张立军. 儿童股骨干骨折的规范化治疗. 中国骨与关节杂志, 2015, 4(10): 766-770.
6.	张磊, 左玉明, 王月光, 等. 大粗隆顶点开口顺行带锁髓内钉治疗青少年股骨干骨折疗效观察. 中国修复重建外科杂志, 2017, 31(3): 262-265.
7.	卢育南, 林然, 潘诺琪, 等. Bouquet技术治疗儿童不稳定型股骨干骨折的疗效分析. 中华创伤骨科杂志, 2022, 24(12): 1042-1048.
8.	王宣, 刘玉昌, 韩久卉, 等. 外固定架辅助弹性髓内钉治疗儿童四肢干部骨折. 中国矫形外科杂志, 2021, 29(16): 1530-1532.
9.	孙亮, 白锐, 刘万林, 等. 闭合复位刚性髓内钉治疗大龄、高体重儿童及青少年股骨干骨折. 实用骨科杂志, 2020, 26(10): 873-876.
10.	陈伟, 李佳, 张英泽. AAOS《儿童股骨干骨折治疗指南》解读. 中华外科杂志, 2017, 55(1): 44-48.
11.	谢康, 李阳, 张亚鹏, 等. 青少年型锁定髓内钉治疗儿童股骨干骨折的疗效. 临床骨科杂志, 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.	黄佳平, 陈志达, 丁真奇, 等. 交锁髓内钉联合与不联合阻挡螺钉内固定治疗老年股骨干骨折的疗效比较. 中国骨与关节损伤杂志, 2022, 37(2): 186-188.
14.	徐峰, 袁凯旋, 陈圣宝, 等. 髋关节功能评分研究进展. 国际骨科学杂志, 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.	陆定松, 李永刚, 杨志奎, 等. 切开复位交锁髓内钉内固定与闭合复位交锁髓内钉内固定治疗老年股骨干骨折的效果比较. 临床医学研究与实践, 2022, 7(1): 82-85.
19.	张伟, 李建涛, 聂少波, 等. 多维交叉锁定接骨板治疗股骨干髓内钉术后骨不连的临床疗效研究. 中华骨与关节外科杂志, 2021, 14(4): 292-297.
20.	张恒, 李文锐. 影响骨折愈合的因素——应力和微动. 海南医学, 2010, 21(1): 112-116.
21.	邢丹, 马信龙, 宋东辉, 等. 长骨骨折愈合力学环境的研究现状. 生物医学工程与临床, 2012, 16(6): 602-606.
22.	王磊, 李佳, 李涛, 等. 青少年型髓内钉治疗大龄儿童股骨干骨折的近期疗效随访. 中国骨与关节杂志, 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.	刘朝宇, 张建强, 徐文强, 等. 侧卧位斯氏针摇杆技术辅助复位髓内钉固定治疗青少年股骨骨折. 临床小儿外科杂志, 2024, 23(2): 162-167.
26.	马洪, 沈钊雄, 郭跃明. 髓内钉固定治疗青少年股骨干骨折的疗效分析. 中华创伤骨科杂志, 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. 孙超, 刘万林, 韦宜山, 等. 应用弹性髓内针与髋部锁定加压钢板治疗儿童股骨转子下骨折手术潜在风险因素的对比研究. 临床小儿外科杂志, 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. 孙川, 吴永涛, 李敏, 等. 弹性髓内钉固定治疗5~14岁儿童股骨干骨折. 美中国际创伤杂志, 2016, 15(1): 19-21.
5. 张立军. 儿童股骨干骨折的规范化治疗. 中国骨与关节杂志, 2015, 4(10): 766-770.
6. 张磊, 左玉明, 王月光, 等. 大粗隆顶点开口顺行带锁髓内钉治疗青少年股骨干骨折疗效观察. 中国修复重建外科杂志, 2017, 31(3): 262-265.
7. 卢育南, 林然, 潘诺琪, 等. Bouquet技术治疗儿童不稳定型股骨干骨折的疗效分析. 中华创伤骨科杂志, 2022, 24(12): 1042-1048.
8. 王宣, 刘玉昌, 韩久卉, 等. 外固定架辅助弹性髓内钉治疗儿童四肢干部骨折. 中国矫形外科杂志, 2021, 29(16): 1530-1532.
9. 孙亮, 白锐, 刘万林, 等. 闭合复位刚性髓内钉治疗大龄、高体重儿童及青少年股骨干骨折. 实用骨科杂志, 2020, 26(10): 873-876.
10. 陈伟, 李佳, 张英泽. AAOS《儿童股骨干骨折治疗指南》解读. 中华外科杂志, 2017, 55(1): 44-48.
11. 谢康, 李阳, 张亚鹏, 等. 青少年型锁定髓内钉治疗儿童股骨干骨折的疗效. 临床骨科杂志, 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. 黄佳平, 陈志达, 丁真奇, 等. 交锁髓内钉联合与不联合阻挡螺钉内固定治疗老年股骨干骨折的疗效比较. 中国骨与关节损伤杂志, 2022, 37(2): 186-188.
14. 徐峰, 袁凯旋, 陈圣宝, 等. 髋关节功能评分研究进展. 国际骨科学杂志, 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. 陆定松, 李永刚, 杨志奎, 等. 切开复位交锁髓内钉内固定与闭合复位交锁髓内钉内固定治疗老年股骨干骨折的效果比较. 临床医学研究与实践, 2022, 7(1): 82-85.
19. 张伟, 李建涛, 聂少波, 等. 多维交叉锁定接骨板治疗股骨干髓内钉术后骨不连的临床疗效研究. 中华骨与关节外科杂志, 2021, 14(4): 292-297.
20. 张恒, 李文锐. 影响骨折愈合的因素——应力和微动. 海南医学, 2010, 21(1): 112-116.
21. 邢丹, 马信龙, 宋东辉, 等. 长骨骨折愈合力学环境的研究现状. 生物医学工程与临床, 2012, 16(6): 602-606.
22. 王磊, 李佳, 李涛, 等. 青少年型髓内钉治疗大龄儿童股骨干骨折的近期疗效随访. 中国骨与关节杂志, 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. 刘朝宇, 张建强, 徐文强, 等. 侧卧位斯氏针摇杆技术辅助复位髓内钉固定治疗青少年股骨骨折. 临床小儿外科杂志, 2024, 23(2): 162-167.
26. 马洪, 沈钊雄, 郭跃明. 髓内钉固定治疗青少年股骨干骨折的疗效分析. 中华创伤骨科杂志, 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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