AVASCULAR NECROSIS OF THE FEMORAL-HEAD AS A SERIOUS COMPLICATION FOLLOWING FEMORAL NAILING IN CHILDREN AND ADOLESCENTS

Nailing of femoral fractures before closure of the growth plates may l ead to avascular necrosis of the femoral head in 3-4% of cases. In add ition to the 14 cases described in the literature we present 3 more. A nalysis of these cases reveals a common pathogenesis. The nails were a ll inserted anterograde and were designed for the adult femur. The pro blem appears to be related to the large diameter of the nail and its e ntry point in the relatively small femoral neck basis, close to the ve ssels supplying the femoral head. The role of the open physis remains unclear. Even though the complication of femoral head necrosis is rare , it is a severe complication. Therefore we do not recommend anterogra de femoral nailing, using the classic entry point, in children or adol escents. We believe that there is a need for a new design of femoral n ail. If both femoral head necrosis and coxa valga are to be avoided, w e suggest that the entry point of the nail should be dorsolateral, bel ow the trochanteric physis.