Orthopaedic Surgery

Answer 6 Lower rate of fracture malunion. Treatment of femoral shaft fractures in children aged older than 6 years remains a controversial topic. A systematic review of 2422 femoral shaft fractures found a significantly lower number of malunions, leg length discrepancies, and total adverse events with intramedullary fixation as compared with casting and external fixation.5 Flexible nails are typically used in patients with open proximal femoral growth plates and mid-shaft femur fractures with minimal comminution. Use of flexible nails allows for early mobilization, and thus patients can meet recovery milestones earlier.6 Higher rates of fracture malunion or nonunion and increased risk of leg length discrepancy are all linked to casting and nonoperative treatment of pediatric femoral shaft fractures. Osteonecrosis of the femoral head is not associated with flexible nailing of femoral shaft fractures but has been found in conjunction with antegrade femoral nails with piriformis entry in children. REFERENCES 5. Poolman RW, Kocher MS, Bhandari M. Pediatric femoral fractures: a systematic review of 2422 cases. J Orthop Trauma 2006;20:648–54. 6. Flynn JM, Schwend RM. Management of pediatric femoral shaft fractures. J Am Acad Orthop Surg 2004;12:347–59. Click here to return to the questions

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