[Intramedullary stabilization of pediatric diaphyseal femur fractures with elastic Ender nails]

We evaluated the results of intramedullary stabilization of pediatric diaphyseal femur fractures with elastic Ender nails.

Twenty-six children (19 boys, 7 girls, mean age 8.9 years, range 5.9 to 12.3 years) were stabilized with flexible intramedullary Ender nails placed by the retrograde technique. Nineteen were isolated femoral fractures. The fractures occurred in the middle third (n=18), distal third (n=5), and proximal third (n=3) of the femur. The mean follow-up was 22.3 months (range 8 to 47 months). Radiologically, anteroposterior and lateral radiographs were evaluated. To determine leg length discrepancy, 25 children had scanograms beyond 12 months. Clinically, the level of the hip and knee motion and walking patterns were evaluated.

Union was achieved in all patients within a mean of 6.6 weeks (range 5 to 12 weeks). Twenty-four fractures healed with a normal anteroposterior alignment while two children had 5 degrees varus and 7 degrees valgus, respectively. Lateral radiographs showed an anterior angulation of 7 degrees and a posterior angulation of 6 degrees in two patients, respectively. The femur length remained equal to that of the contralateral side in 19 patients (76%), whereas it exceeded by a mean of 7 mm in four, and shortened by a mean of 6 mm in two children. All patients but one had a symmetric walking pattern. All children but one had a normal range of hip and knee motion. No instances were observed concerning delayed union, infection, nonunion, rod fractures, growth arrest, injury to the femoral epiphysis, or refractures after rod removal.

Intramedullary nailing with the use of elastic Ender nails provided effective fixation in the treatment of femoral shaft fractures in children 6 to 12 years of age.