It has now been well established that the management of fractures of  femur in the adolescent age group  are best managed by  reduction and  secure internal fixation rather than non surgical conservative sort of treatment .This results in better outcomes including quicker healing  and the less  eventful complication of  avascular necrosis (AVN)  of the head of femur and length discrepancy , earlier ambulation and weight bearing, better psychosocial results and shortened hospital stay. Subtrochanteric fractures of the femur implement more challenges in management as they hold limited ability to compensate for malalignment with the presence of deforming muscle forces.
There is a lack of agreement regarding definition of the fractures .
Mathew and Jeffrey: it is subtrochanteric femoral fracture in pediatrics when the fracture distance  is less than 10% from lesser trochanter compared to total shaft length , an area in which the muscle deforming action results in difficulty to control reduction

Modalities of internal fixation include:
. titanium elastic nails (TEN)
. cephalomedullary nails (CM)
. interlocking nails
. Smith Peterson plates
. plate and hip screw
. nail and intramedullary hip screw and cancellous screws.

For the management of this injury we use trochanteric antigrade nail (TAN), a rigid intramedullary nail with a trochanteric entry point
Purpose is to decrease wound dissection and to provide secure fixation that will enhance ambulation and full weight bearing which in turn will make a more satisfactory post-operative period, thus a quicker return to pre-operative activities,  and augment bone healing

Share Medical Presentations