EFFICACY AND ADVERSE EFFECTS OF FLEXIBLE INTRAMEDULLARY NAILING FOR DIAPHYSEAL FEMUR FRACTURES IN CHILDREN

Fractures of the shaft of femur are uncommon but significant injuries in children, constituting less than 2 percent of all skeletal injuries in children. These fractures are sustained more commonly in early childhood and adolescence. We report a retrospective analysis of 35 consecutive children (36 fractures) between the ages of 5 to 16 years who underwent elastic stable intramedullary nailing for acute traumatic femoral shaft fractures from May 2003 to September 2010. The mean follow up was 45 weeks. The mean time to radiological union was 7.25 weeks. Major complications were identified in 4 patients while minor complications were noted in 3 patients. We obtained excellent and good results in 89 percent of patients and poor results in 11 percent of patients. The poor reported results were predominantly due to knee stiffness and in one case due to malunion in an unstable injury and could be avoided by adhering to surgical case selection and protocol. Our results demonstrate that elastic stable intramedullary nailing of femoral shaft fractures in children between 5 to 16 years is predictable, effective and safe. Because of the early weight bearing, minimal duration of hospital stay, small skin incisions for the insertion of the nail, elastic stable intramedullary nailing may be considered akin to a physiological method of treatment.