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Published on: June 6, 2025
Preliminary Report: Pediatric Femur Fractures: Single Incision Intramedullary Stabilization Technique
Matthew Knedel1, Edward W Gallego, Joseph Gerardi
1*Children's Hospital Central California, UCSF Fresno, Department of Orthopaedic Surgery †UCSF Fresno, Department of Orthopaedic Surgery, Fresno, CA.
Insights
A single incision technique for pediatric femoral shaft fractures offers outcomes equivalent to the traditional two-incision method. This approach may also reduce infection risk and improve cosmetic results in pediatric fracture stabilization.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
Background:
- Pediatric femoral shaft fractures are common.
- Surgical stabilization trends toward flexible intramedullary nails.
- Traditional technique uses two incisions.
Purpose of the Study:
- To evaluate a single-incision technique for pediatric femoral shaft fracture stabilization.
- To compare outcomes with the standard two-incision technique.
- To assess cosmesis and infection risk.
Main Methods:
- Retrospective review of 46 pediatric femoral shaft fracture cases (23 single, 23 double incision).
- Fracture classification using AO classification.
- Assessment of time to fracture union and complications.
Main Results:
- No significant difference in fracture healing times between single (62.4 days) and double incision (50.3 days) groups (P=0.38).
- One superficial infection in the two-incision group; no statistically significant difference.
- No malunions or nonunions observed in either group.
Conclusions:
- Single-incision technique is a viable option for pediatric femoral shaft fracture stabilization.
- Equivalent time to union and complication rates compared to the two-incision technique.
- Potential benefits include reduced infection risk and improved cosmesis.
Background:
Pediatric femoral shaft fractures are common injuries that have seen a trend toward surgical stabilization. Traditionally these fractures have been stabilized with flexible intramedullary nails performed through a 2-incision technique. We proposed that a single incision technique would offer equivalent outcomes with the potential for improved cosmesis and a reduced infection risk.
Methods:
A retrospective review was performed of 112 consecutive cases of pediatric femoral shaft fractures, 66 cases were excluded, leaving 23 cases utilizing the single incision technique and 23 utilizing the standard 2-incision technique. Electronic medical records were then reviewed for demographic information, and a PAC system was employed to classify the fractures according to the AO classification and determine the time to fracture union.
Results:
No significant difference was found in fracture healing times with a mean union time of 62.4 and 50.3 days in the single and double incision groups, respectively (P=0.38). One complication of superficial infection was noted in the 2-incision group; however, this was not statistically significant, and no malunions or nonunions were detected in either group.
Conclusions:
A single incision technique for intramedullary stabilization of pediatric femoral shaft fractures is a viable option with an equivalent time to fracture union and no observed difference in the complication rate. Furthermore, the technique may offer benefits with regard to infection risk and cosmesis.
