Flexible intramedullary nailing in paediatric femoral fractures. A report of 73 cases

We included 73 femoral shaft fractures in 69 patients treated with retrograde flexible intramedullary nailing with a minimum follow up of 5 years. Final limb length discrepancy and any angular or rotational deformities were determined.Mean age at final follow up was 15.5 years (10-21 years). Mean follow up was 7.16 years (5.0-8.6 years). Titanium and stainless steel nails were used in 43 and 30 cases respectively. There were 51 midshaft, 17 proximal, and 5 distal fractures.All fractures united at an average of 11 weeks but asymptomatic malalignment and LLD were seen in 19% and 58% fractures respectively. LLD ranged from -3 cm to 1.5 cm. Other complications included superficial infection(2), proximal migration of nail(3), irritation at nail insertion site(5) and penetration of femoral neck with nail tip(1). There were 59 excellent, 10 satisfactory and 4 poor results.Flexible intramedullary nailing is reliable and safe for treating paediatric femoral shaft fractures. It is relatively free of serious complications despite asymptomatic malalignment and LLD in significant percentage of fractures.After acute infections, trauma is a leading cause of morbidity and mortality in children [1,2]. Although accounting for less than 2% of all orthopaedic injuries in children [3], femoral fractures have a significant impact not only on the patient and their family network, but also on regional trauma resources [4,5]. These fractures have been managed with wide variety of methods in past. Historically treatment with closed means in plaster spica cast, either immediately or after a period of traction, has yielded acceptable results for these fractures [6-8] but this treatment produces undue physical and psychological stress for patient and family [9-11]. Furthermore, in certain complex fractures and sometimes in subtrochantric fractures, with tendency for marked flexion of proximal fragment, closed reduction and its maintenance if often unsuccessful. Last few decades has seen increas