Efficacy analysis of treatment of femoral shaft fractures in adolescents with elastic intramedullary nail

Objective: To investigate the clinical efficacy of treatment of femoral shaft fractures in adolescents with elastic intramedullary nail. Methods From March 2016 to January 2022, the data of 59 cases of adolescent femoral shaft fractures treated by elastic intramedullary nail in the Pediatric Orthopaedic Hospital, Honghui Hospital, Xi’an Jiaotong University were analyzed retrospectively. We were able to follow-up on 59 patients (34 males, 25 females); Mean age at fracture was 13 (11 ~ 18) years; Body weight: 38 ~ 62kg, average 48kg. The time from injury to surgery ranged from 2 to 7 days. The average was 3.8 days. All operations were fixed with elastic intramedullary nails, and external fixation was fixed with hip herringbone plaster or brace. Record the operation time, intraoperative blood loss, diameter of elastic intramedullary nail, external fixation method, hospital stay, fracture healing time, etc. Results Surgery took 60 ~ 180 minutes, with an average of 110 minutes. Intraoperative blood loss: 5 ~ 30ml, average 14ml. Elastic intramedullary nail diameter: Of these, 24 patients used 4.0mm; 35 patients used 3.5mm. External fixation: hip herringbone plaster fixation in 45 cases; 14 cases were fixed with brace. Patients were hospitalised for 4 ~ 14 days, averaging 7 days. Mean post-operative follow-up of 18 months (12–36 months). The fracture healing time was 3 to 8 months (average 4.6 months). The internal fixation was taken out from 11 to 20 months after operation, with an average of 13 months. During the follow-up period, no patient had complications such as femoral head necrosis, infection, nonunion of fracture, delayed union, malunion and nail withdrawal. At the last follow-up, the lower limbs of two patients were not equal in length, but the difference was less than 1 cm. Conclusions The treatment of femoral head fractures in adolescents with flexible intramedullary nailing is simple, with less bleeding, fewer complications, less impact on limb development, and definite efficacy.