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Published on: June 6, 2025
ediatric femoral shaft fractures treated by flexible intramedullary nailing
K C Kapil Mani1, R C Dirgha Raj, Acharya Parimal
1Department of Orthopaedics, Civil Service Hospital, Kathmandu, Nepal.
Insights
Stainless steel flexible intramedullary nails offer rapid union and recovery for pediatric femoral shaft fractures in children aged 5-13. This operative approach reduces immobilization and psychological impact, proving cost-effective.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Pediatric femoral fractures increasingly managed operatively for faster recovery.
- Children aged 5-13 typically treated with traction, hip spica, flexible nails, or external fixators.
- Study focuses on evaluating stainless steel flexible intramedullary nail outcomes for pediatric femoral shaft fractures.
Purpose of the Study:
- Evaluate the efficacy of stainless steel flexible intramedullary nails.
- Assess outcomes in pediatric patients aged 5-13 with femoral shaft fractures.
- Compare operative treatment with flexible intramedullary nails against traditional methods.
Main Methods:
- 32 pediatric femoral shaft fractures treated with stainless steel flexible intramedullary nails.
- All procedures performed under fluoroscopic guidance with long leg cast application.
- Post-operative evaluation included fracture alignment, union time, infection, and limb length discrepancy.
Main Results:
- 28 of 32 patients followed up; average age 8.14 years.
- Mean hospital stay was 4 days; average fracture union time was 9.57 weeks.
- Minor complications included varus/anterior angulation and limb lengthening.
Conclusions:
- Flexible intramedullary nailing provides rapid union and recovery for pediatric femoral shaft fractures.
- Treatment leads to shorter rehabilitation periods and reduced immobilization.
- This method is cost-effective with less psychological impact on young patients.
Background:
Nowadays pediatric femoral fractures are more commonly managed with operative treatment rather than conservative treatment because of more rapid recovery and avoidance of prolonged immobilization. Children between the ages of 5-13 years are treated either by traction plus hip spica and flexible/elastic stable retrograde intramedullary nail, or external fixators in the case of open fractures. The aim of this study is to evaluate the outcome of pediatric femoral shaft fractures treated by stainless steel flexible intramedullary nail in children between 5 and 13 years of age.
Methods:
There were 32 cases of femoral shaft fractures which were all fixed with stainless steel flexible intramedullary nail under fluoroscopy. Long leg cast was applied at the time of fixation. Partial weight bearing was started 2 weeks after surgery. Patients were evaluated in follow-up study to observe the alignment of fracture, infection, delayed union, nonunion, limb length discrepancy, motion of knee joint, and time to unite the fracture.
Results:
We were able to follow up 28 out of 32 patients. The patients were 8.14 years of age on average. The mean hospital stay after operation was 4 days and fracture union time was 9.57 weeks. There were 3 cases of varus angulation, 2 cases of anterior angulation, and 4 cases of limb lengthening.
Conclusion:
Patients aged between 5 and 13 years treated with flexible intramedullary nail for closed femoral shaft fracture have rapid union and recovery, short rehabilitation period, less immobilization and psychological impact, and cost-effective.
