Abstract：Objective To explore the close reduction and rigid intramedullary nailing fixation of femoral shaft fracture in older and over-weighted children and adolescent. Methods Our hospital used closed reduction rigid intramedullary nail internal fixation to treat 25 cases of older and over-weighted children and adolescent with femoral shaft fractures from January 2010 to June 2018.There were 19 males and 6 females，18 cases had the left side fracture and 7 cases had the right side fracture.The patients had an average age of (13.52±2.49) years (range：10~18) and a average weight of (50.35±7.54) kg (42~75).We analyzed the postoperative clinical，radiological results and complications.Results All patients had no complications such as avascular necrosis of femoral head，proximal femoral deformity，unequal length of both lower limbs，delayed healing and non-union of bone，dysfunction and other complications.One of them (4%) developed postoperative infection，which had been cured.At the last follow-up，Harris function score and knee function function AKS score：20 cases were excellent，80%；4 cases were good，16%；1 case was acceptable，4%.Conclusion Femoral shaft fractures in older and over-weighted children and adolescent are extremely challenging fractures.The use of closed reduction rigid intramedullary internal fixation can achieved satisfactory treatment results and is a feasible treatment option.
［1］Flynn JM，Schwend RM.Management of pediatric femoral shaft fractures［J］.J Am Acad Orthop Surg，2004，12(5)：347-359.
［2］陈伟，李佳，张英泽.AAOS《儿童股骨干骨折治疗指南》解读［J］.中华外科杂志，2017，55(1)：44-48.
［3］Harris WH.Traumatic arthritis of the hip after dislocation and acetabular fractures：treatment by mold arthroplasty：an end-result study using a new method of result evaluation［J］.J Bone Joint Surg(Am)，1969，51(4)：737-755.
［4］Ghani H，Maffulli N，Khanduja V.Management of stiffness following total knee arthroplasty：A systematic review［J］.Knee，2012，19(6)：751-759.
［5］Cunha FMD，Figueiredo LAD，Coelho LFA，et al.Fraturas diafisarias de femur em crianas e adolescentes［J］.Acta Ortopedica Brasilra，2007，15(2)：80-83.
［6］Ramseier LE，Janicki JA，Weir S，et al.Femoral fractures in adolescents：a comparison of four methods of fixation［J］.J Bone Joint Surg(Am)，2010，92(5)：1122-1129.
［7］孙川，吴永涛，李敏，等.弹性髓内钉固定治疗5~14岁儿童股骨干骨折［J］.美中国际创伤杂志，2016，15(1)：19-21.
［8］黄立明，汪文涛，潘源城，等.带锁髓内钉和锁定钢板治疗青少年股骨干骨折的对比研究［J］.临床小儿外科杂志，2019，18(2)：124-129.
［9］Miner T，Carroll KL.Outcomes of external fixation of pediatric femoral shaft fractures［J］.J Pediatr Orthop，2000，20(3)：405-410.
［10］Moroz LA，Launay F，Kocher MS，et al.Titanium elastic nailing of fractures of the femur in children.Predictors of complications and poor outcome［J］.J Bone Joint Surg(Br)，2006，88(10)：1361-1366.
［11］Canavese F，Marengo L，Andreacchio A，et al.Complications of elastic stable intramedullary nailing of femoral shaft fractures in children weighing fifty kilograms (one hundred and ten pounds) and more［J］.Intern Orthop，2016，40(12)：2627-2634.
［12］Hoon P，Woo KH.Treatment of femoral shaft fracture with an interlocking humeral nail in older children and adolescents［J］.Yonsei Med J，2012，53(2)：408-415.
［13］MacNeil JAM，Francis A，El-Hawary R.A systematic review of rigid，locked，intramedullary nail insertion sites and avascular necrosis of the femoral head in the skeletally immature［J］.J Pediatr Orthop，2011，31(4)：377-380.
［14］Knapik DM，Mccarthy C，Liu RW.Developmental patterns of the greater trochanter in skeletally immature patients［J］.J Pediatr Orthop，2019，39(6)：e412-416.
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