Although femoral shaft fractures are common in children, treatment using rigid intramedullary nail fixation remains controversial owing to concerns of avascular necrosis (AVN) and disruption of growth of the proximal femur. We examined studies on AVN complications and proximal femur deformity after rigid nail fixation in children aged 6 to 12 years. Of the 13 studies included, nine had no incidents of AVN or clinically significant proximal femur deformity using a greater trochanter entry point. Four studies showed cases of AVN or proximal femoral deformity in patients treated with intramedullary nails through a starting point at or near the piriformis fossa or the tip of the greater trochanter. The findings of this review suggest that antegrade rigid intramedullary nailing may be an acceptable treatment option for femoral shaft fractures in children aged 6 to 12 years, especially when the lateral aspect of the greater trochanter is used as the entry point. Results of future research are needed on age-related outcomes and complications of rigid intramedullary nailing fixation of femoral shaft fractures in children.



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