Journal of Pediatric Orthopaedics - 2026-05-11 - Journal Article
Intramedullary Nailing Versus Plate Fixation for Femoral Derotational Osteotomy in Adolescents: A Randomized Controlled Trial.
Grønseth A, Rysst-Heilmann AMS, Terjesen T, Horn J
Topics
Key Takeaway
Intramedullary nailing achieves rotational correction within 6.6±4.9 degrees of planned derotation—noninferior to plate fixation by an intergroup difference of only 0.7 degrees—in adolescent femoral derotational osteotomy.
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Summary
This RCT asked whether intramedullary nailing is noninferior to proximal femoral plate fixation for rotational correction accuracy in adolescents aged 10–18 with symptomatic increased femoral anteversion undergoing femoral derotational osteotomy. CT-measured deviation from planned correction was 6.6±4.9 degrees with an intergroup difference of 0.7 degrees (P=0.586), confirming noninferiority. All 49 osteotomies healed within 6 months, no avascular necrosis occurred, and CHOHES, KOOS-child, and KIDSCREEN-27 scores improved equivalently in both groups at 1 year, though IMN patients achieved full weight bearing earlier.
Key Limitation
The trial enrolled only 31 patients across 49 osteotomies, making it underpowered to detect differences in low-frequency but high-stakes complications such as implant failure, malrotation requiring revision, or physeal injury.
Original Abstract
BACKGROUND
Persistent increased femoral anteversion (IFA) in adolescents can cause in-toeing, pain, and functional limitations. Femoral derotational osteotomy is the only effective treatment for symptomatic cases, but the optimal fixation method remains unclear. This randomized controlled trial compared intramedullary nailing with plate fixation, hypothesizing that intramedullary nailing would be noninferior in achieving the intended rotational correction.
METHODS
Adolescents aged 10 to 18 years with symptomatic IFA were randomized to FDO stabilized either with a proximal femoral plate or an intramedullary nail. The primary outcome was correction accuracy, defined as the difference between planned and achieved derotation measured on postoperative CT. Secondary outcomes included hip rotation, radiographic healing, complications, operative metrics, patient-reported outcome measures (CHOHES, KOOS-child, KIDSCREEN-27), and patient satisfaction. Follow-up assessments were performed at 6, 12, 26, and 52 weeks.
RESULTS
Thirty-one adolescents (49 osteotomies) with a mean age of 13.4±1.8 were analyzed. Intramedullary nailing was noninferior to plate fixation, with a mean deviation from the intended correction of 6.6±4.9 degrees and an intergroup difference of 0.7 degrees ( P =0.586). All osteotomies healed within 6 months, and no cases of avascular necrosis occurred. Both groups demonstrated significant improvements in hip rotation and patient-reported outcomes at 1 year, without significant differences between techniques. Operative time was slightly longer with intramedullary nailing, whereas this group achieved full weight bearing slightly earlier.
CONCLUSIONS
Intramedullary nailing achieves rotational correction accuracy comparable to plate fixation, with reliable healing and similar functional outcomes. Given its minimally invasive nature and allowance for immediate postoperative weight bearing, it represents an effective alternative for adolescents undergoing femoral derotational osteotomy.
LEVELS OF EVIDENCE
Level I-randomized controlled trial.