Femoral intramedullary nailing in the growing child.

The outcome of intramedullary nailing in 17 femoral fractures was studied in children aged 5 to 12 years. By this age independent vascularity of the capital femoral epiphysis has become established. Indications were: severely displaced diaphyseal fractures uncontrolled by closed reduction in patients with head injury or multiple trauma. All were treated by open reduction and retrograde nailing using Rush pins or Kuntscher nails. All children became community ambulators and were followed until maturity. There were no significant rotational deformities and leg length discrepancy due to overgrowth was less than 1.0 cm at termination of growth. Growth arrest of the greater trochanter was seen in three hips that were reamed for Kuntscher nailing but in none of those fixed with Rush pins. Retrograde Rush pinning appears to be a safe and effective procedure that avoids insult to the proximal femoral blood supply. Growth plate changes did not significantly affect hip function.