INTERNAL-FIXATION OF FEMORAL-SHAFT FRACTURES IN CHILDREN AND ADOLESCENTS - A 10-YEAR TO 21-YEAR FOLLOW-UP OF 52 FRACTURES

In a long-term follow-up (mean 16 years) of 52 femoral shaft fractures treated by internal fixation in 50 children and adolescents, we noted a mean overgrowth of 1 mm after plating and a mean undergrowth or rel ative shortening of 2 and 9 mm after nailing with broad (IMN) and slen der (flexible rods: IMR) intramedullary nails, respectively. The mean overgrowth was 8 mm in children, but adolescents had a mean undergrowt h of 5 mm (p < 0.01). Excessive overgrowth tended to occur less freque ntly after intramedullary nailing than after plating (p = 0.1). Underg rowth tended to occur with increasing frequency with increasing age an d attained troublesome levels in three patients with severe trauma. Th ree cases of moderate valgus deformity of the hip and one case of late arthrosis of the hip occurred after intramedullary nailing with IMN i ntroduced through the greater trochanter. We conclude that this method should not be used in patients with open physes.