Crossing the growth plate: distal femoral physeal response to intramedullary nailing in a porcine model
4 affiliations
- 1Interdisciplinary Orthopaedics, Aalborg University Hospital
- 2Department of Orthopaedics, Aarhus University Hospital
- 3Department of Materials and Production, Aalborg University
- 4Additive Manufacturing, Danish Technological Institute
Abstract
Intramedullary nailing is widely used for femoral stabilization. Yet, its effect on the distal femoral physis in skeletally immature patients remains incompletely defined. In this study, retrograde femoral nailing was performed in 19 juvenile pigs using either titanium or stainless-steel implants, with the contralateral limb serving as an internal control. Growth and alignment were assessed at short-term and long-term follow-up using two-dimensional computed tomography-based measurements and a three-dimensional analysis of femoral length, distal femoral volume, and angular alignment. At short term, femora showed small reductions in relative longitudinal growth and distal femoral volume compared with contralateral non-operated. At long-term follow-up, the mean paired differences between operated and contralateral femora were − 1.3% for relative femoral length (Hodges–Lehmann) estimate − 1.4%, 95% CI − 2.4 to − 0.2) and − 4.3% for distal femoral volume (HL estimate − 5.3%, 95% CI − 8.8 to 0.02). Overall trends were similar for titanium and stainless-steel implants in both short and long-term; however, stainless-steel nails showed a slightly greater distal femoral volume reduction at long-term follow-up. Angular changes were small and variable in direction, with no systematic alignment pattern observed. Overall, limited central violation up to 6% of the distal femoral physis in this porcine model appeared to be well tolerated under controlled experimental conditions and was associated with only small reductions in femoral length and distal volume, without evidence of meaningful angular malalignment.
Related
- Prophylactic Intramedullary Nailing Following Femoral Lengthening in Congenital Femoral Deficiency: A Retrospective Comparative Study
- Robot-assisted navigation combined with a double reverse traction reduction frame for retrograde intramedullary nailing of extra-articular distal femoral fractures: a retrospective comparative cohort study
- Lateral-Only Flexible Intramedullary Nailing for Pediatric Tibial Shaft Fractures: An Early Comparative Experience With a Novel Technique to Reduce Symptomatic Implant Prominence
- Radiographic union rate and predictors of nonunion after primary surgical implant generation network intramedullary nailing for open tibial shaft fractures at a major trauma center in Ethiopia
- Epidemiology, determinants, and microbiological profile of implant-associated infections following intramedullary nailing in a tertiary hospital in Ethiopia.
BibTeX
@article{tirta2026crossing,
title = {{Crossing the growth plate: distal femoral physeal response to intramedullary nailing in a porcine model}},
author = {Maria Tirta and Shima Gholinezhad and Ole Rahbek and Ahmed Halloum and Jan Duedal Rölfing and Jacob Schade Engbjerg and John Rasmussen and Jeppe Byskov and Søren Kold},
journal = {Scientific Reports},
year = {2026},
month = jul,
doi = {10.1038/s41598-026-63452-9},
url = {https://doi.org/10.1038/s41598-026-63452-9},
note = {CC BY},
}
RIS
TY - JOUR
TI - Crossing the growth plate: distal femoral physeal response to intramedullary nailing in a porcine model
AU - Maria Tirta
AU - Shima Gholinezhad
AU - Ole Rahbek
AU - Ahmed Halloum
AU - Jan Duedal Rölfing
AU - Jacob Schade Engbjerg
AU - John Rasmussen
AU - Jeppe Byskov
AU - Søren Kold
PY - 2026
DA - 2026/07/01
JO - Scientific Reports
DO - 10.1038/s41598-026-63452-9
UR - https://doi.org/10.1038/s41598-026-63452-9
AB - Intramedullary nailing is widely used for femoral stabilization. Yet, its effect on the distal femoral physis in skeletally immature patients remains incompletely defined. In this study, retrograde femoral nailing was performed in 19 juvenile pigs using either titanium or stainless-steel implants, with the contralateral limb serving as an internal control. Growth and alignment were assessed at short-term and long-term follow-up using two-dimensional computed tomography-based measurements and a three-dimensional analysis of femoral length, distal femoral volume, and angular alignment. At short term, femora showed small reductions in relative longitudinal growth and distal femoral volume compared with contralateral non-operated. At long-term follow-up, the mean paired differences between operated and contralateral femora were − 1.3% for relative femoral length (Hodges–Lehmann) estimate − 1.4%, 95% CI − 2.4 to − 0.2) and − 4.3% for distal femoral volume (HL estimate − 5.3%, 95% CI − 8.8 to 0.02). Overall trends were similar for titanium and stainless-steel implants in both short and long-term; however, stainless-steel nails showed a slightly greater distal femoral volume reduction at long-term follow-up. Angular changes were small and variable in direction, with no systematic alignment pattern observed. Overall, limited central violation up to 6% of the distal femoral physis in this porcine model appeared to be well tolerated under controlled experimental conditions and was associated with only small reductions in femoral length and distal volume, without evidence of meaningful angular malalignment.
SN - 2045-2322
ER -