Elastic Stable Intramedullary Nailing of Femoral Shaft Fracture-Experience in 48 Children

Background: Femoral shaft fractures are an incapacitating pediatric injury accounting for 1.6% of all pediatric bony injuries. Management of these fractures is largely directed by age, fracture pattern, associated injuries, built of the child and socioeconomic status of the family. We retrospectively evaluated the use of elastic stable intramedullary nail (ESIN) in surgical management of femoral shaft fractures in children and its complications. Methods: Fifty two children were treated with titanium elastic nails (TEN) from June 2009 to June 2014 at our institution. At the end of the study there were 48 children. Fractures were classified according to Winquest and Hansen’s as Grade I (n=32), Grade II (n=10), Grade III (n=6) and compound fractures by Gustilo and Anderson’s classification, Grade I (n=5), Grade II (n=3 ). There were 36 mid-shaft fractures, 7 proximal third shaft fractures, 5 distal third shaft fractures. The final results were clinically evaluated by using Flynn’s criteria and radiologically by Anthony et al’s criteria. Results: The mean duration of follow-up was 20 months (range 12 – 40 months). All fractures healed radiologically with grade III callus formation at 9 – 12 weeks (mean 9.7 weeks). The results were analyzed using Flynn’s criteria and were excellent in 40 children (83%) and satisfactory in 8 children (17%). The soft tissue discomfort near the knee produced by nail ends was the most common problem in our study (25%). Other complications include limb shortening (n=5), Varus malunio‎n (n=4), Nail protruding site infection (n=4) and nail migration (n=2). There was no delayed unio‎n, non-unio‎n or refractures. Conclusion: TEN is minimally invasive, safe, relatively easy to use and an effective treatment for fracture shaft of femur in properly selected children. Level of evidence: III