Related Experiment Video
Updated: Jun 18, 2026
Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Flexible intramedullary nailing in paediatric femoral shaft fractures
John Anastasopoulos1, Dimitrios Petratos, Charalampos Konstantoulakis
12nd Orthopaedic Department, Aghia Sophia Childrens' Hospital, Thivon and Papadiamadopoulou, Goudi, Athens 11527, Greece.
Insights
Flexible intramedullary nails effectively treat pediatric femoral shaft fractures, leading to union and full motion with minimal complications. While radiographic malalignment occurred, it did not result in functional issues or require revision surgery.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Pediatric femoral shaft fractures require effective fixation.
- Flexible intramedullary (IM) nailing is a potential treatment option.
Purpose of the Study:
- To evaluate the efficacy of flexible IM nails for pediatric femoral shaft fractures.
- To assess union rates, complications, and functional outcomes.
Main Methods:
- Retrospective study of 36 children (37 fractures) treated with flexible IM nails.
- Mean follow-up of 25.5 months.
- Assessment of fracture union, complications, alignment, and leg length.
Main Results:
- All fractures achieved union without re-operation.
- Minor complications included insertion site pain and wound breakdown; no major complications occurred.
- Radiographic malalignment was observed in 44% of cases, but no clinical malalignment or functional problems were reported.
Conclusions:
- Flexible IM nailing is a reliable fixation method for pediatric femoral shaft fractures.
- The technique has a small learning curve and allows early mobilization.
- Minor complications are often technique-related and avoidable.
Abstract:
This retrospective study aims to evaluate the efficacy of flexible intramedullary (IM) nails as a fixation device of paediatric femoral shaft fractures. A total of 36 children with 37 closed fractures were treated by this method. The patients ranged in age from 7.2 to 13.5 years and the mean follow-up was 25.5 months. All patients had open femoral growth plates at the time of surgery. All fractures united and none of the patients needed re-operation. Complications included pain/irritation at the insertion site, superficial wound breakdown and one case of delayed union. No major complications were recorded. After nail removal, all children had full range of hip and knee motion. At final follow-up, although radiographs revealed that 44% of the children had malalignment at the fracture site in one or both planes, none of the children presented with clinical malalignment of the fractured limb. Maximum angulation that was calculated on the coronal plane was 5 degrees into varus and on the sagittal plane 7 degrees of anterior angulation (apex posteriorly). Leg-length discrepancy was assessed clinically and radiographically when needed. A total of 50% of the children had a leg-length inequality but none of them complained of a functional problem. Flexible nailing of diaphyseal fractures of the femur is a reliable method with a small learning curve and allows early mobilisation. Most of our minor complications were technique related and could be avoided.
