Burying flexible intramedullary nails improves implant survival and reduces tip-related complications in nonambulatory children with cerebral palsy.

Abstract

Closed diaphyseal femoral fractures in children with cerebral palsy classified as Gross Motor Function Classification System (GMFCS) levels IV/V are frequently managed with flexible intramedullary nails (FIN). This study aimed to evaluate the survival of FIN with distal ends buried within the distal femoral metaphyseal cortex. Secondary outcomes included the occurrence of complications, especially those requiring reoperation. Children were divided into two groups based on the location of the distal nail. In group A, the nail ends were buried within the distal femoral metaphyseal cortex. In group B, the ends extended just beyond the cortex. FIN survival was defined as retention without the need for removal or replacement. Twenty children met the inclusion criteria: nine females (45%) and 11 males (55%). Mean age was 10.4 ± 3.7 years. GMFCS IV: five children (25%), GMFCS V: 15 children (75%). Mean follow-up was 7.5 ± 2.9 years. Group A consisted of nine children (45%) and group B, 11 children (55%). Implant survival was 100% in group A and 58.3% in group B (P = 0.033). No significant differences were observed between groups in nail diameter, estimated blood loss, surgical time, length of hospitalization, or incidence of complications. In conclusion, burying the distal ends of FIN within the distal femoral metaphyseal cortex in nonambulatory children with cerebral palsy and an isolated closed femoral diaphyseal fracture were associated with significantly higher implant survival without increased complications or reoperation. However, potential intraoperative challenges associated with retained FIN during future femoral procedures should be carefully considered before adopting this technique. Level of Evidence: Level III, Retrospective Cohort Study.