Original Research
Use of Flexible Intramedullary Nail Fixation in Treating Femur Fractures in Children
Am J Orthop. 2009 March;38(3):E49-E55
Author and Disclosure Information
Michael Khazzam, MD, Channing Tassone, MD, Xue C. Liu, PhD, MD, Roger Lyon, MD, Brian Freeto, MD, Jeffery Schwab, MD, and John Thometz, MD
Dr. Khazzam is Orthopaedic Surgery Resident, Department of Orthopaedics, University of Missouri, Columbia, Missouri.
Dr. Tassone is Assistant Professor, Department of Orthopaedic Surgery, Dr. Liu is Associate Professor, Musculoskeletal Functional Assessment Center, Department of Orthopaedic Surgery, Dr. Lyon is Associate Professor, Dr. Freeto is Resident, and Dr. Schwab is Professor and Chairman, Department of Orthopaedic Surgery, and Dr. Thometz is Chief, Pediatric Orthopaedic Surgery, and Professor, Department of Orthopaedic Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
We evaluated use of flexible intramedullary nails in the surgical treatment of femoral shaft fractures in 135 children (138 fractures). Mean age was 9.7 years (range, 2-17 years). Mean follow-up was 15.6 months (range, 6.6-53.5 months). Seventy-two patients were treated with stainless-steel (Ender) nails and 66 with titanium elastic nails. There were 73 midshaft fractures, 48 proximal-third fractures, and 17 distal-third fractures. Fracture patterns were transverse (66), oblique (42), spiral (24), and comminuted (6). There were 16 complications—3 refractures, 2 delayed unions, 3 varus or valgus malalignments, 5 nail-tip irritations, 2 broken interlocking screws (found incidentally on radiographs), and 1 asymptomatic proximal nail migration—for a complication rate of 11.7%. These results demonstrate that use of flexible intramedullary nails in the treatment of femoral shaft fractures in children is successful regardless of patient age, fracture
location, or fracture pattern.