Neurologic complications of pediatric femoral nailing

Neurologic complications of femoral rodding with interlocking nails were investigated in 35 consecutive pediatric patients, aged 10-17 years, with traumatic femur fractures. We examined various risk factors for neurologic complications, including timing and duration of surgery, preoperative and intraoperative traction type, adequacy of preoperative traction, intraoperative patient position, degree of comminution of the fracture, and use of interlocking screws. There were eight (22.2%) neurologic complications. Of these, only two (5.6%) persisted for longer than a week. The combination of surgical delay >48 h, preoperative shortening, and the use of boot traction increased the incidence of all palsies to 5.68 times and peroneal palsies to 11.4 times that of patients without this combination of risk factors. Adequate pre- and intraoperative skeletal traction, especially in patients with hours of surgical delay, may decrease the incidence of neurologic complications in pediatric femoral nailings.