Salem KH, Lindemann I, Keppler P Journal of Pediatric Orthopaedics. 2006 Jul-Aug; 26(4):505-9

Femoral, tibial and forearm fractures constitute the most common paediatric long bone injuries. Femoral and tibial fractures are disabling. Conservative management have been the standard of care for these fractures. Unfortunately, these approaches have social, psychological and financial impacts on the child and family. In the past few decades, indications for operative management of these fractures have expanded. Since complications like infection, overgrowth and refracture are associated with plating and external fixators many surgeons started using elastic intramedullary nails inserted percutaneously. This paper summarises the experience of authors using elastic intramedullary nail in the treatment of femoral and tibial shaft fractures.

73 children (48 boys and 25 girls) with mean age of 5.7 years (range, 1.9-11.5 years) among which 68 had femoral and 5 had tibial fracture were treated with elastic intramedullary nails. 3 fractures were compound. All fractures were reduced by closed manipulation and the nails were inserted percutaneously. The median time for anaesthesia and operative procedure was 45 minutes. No significant complication like blood loss, infection, compartment syndrome or neurovascular injury was encountered. Technical problems occurred in a few patients: 2 had short nails and 2 had long nails and 1 had postoperative torsional malalignment. Distal nail migration occurred in 2 children and operative nail shortening was done. All nails were removed after 3 to 7 months (median, 4 months).

All fractures united without additional intervention. The knee and ankle motion were normal in all except one who had an extension lag which later improved. Spiral fractures showed tendency for shortening, transverse patterns had a tendency for lengthening and wedge fractures were associated with external malrotation.

This study demonstrates that elastic stable intramedullary nailing is a successful alternative for treating lower limb fractures in the 2 to 12 years age group and allows early mobilisation with good functional results.