A clinical study of treatment of paediatric femoral shaft fractures with elastic intramedullary nail

Abstract

Background: The fractures of paediatric femoral shaft is a common major fracture treated by Orthopaedic surgeon. The treatment of femoral shaft fractures in children is a subject of controversy. It is conventionally managed by traction and hip spica casting. Although the majority heals without long term sequelae but the closed intramedullary operative procedure allows early weight bearing and early rehabilitation. It has the advantage of haematoma preservation and restoration of continuity of bone.Methods: Twenty one children of aged 6-14 years with femoral shaft fractures were treated with elastic intramedullary nails. Seventeen fractures were in middle third, two in proximal third and two in distal third. Fourteen fractures were transverse, three oblique, two were spiral and two were comminuted. Average injury surgery interval was 5 days. All fractures were treated by closed reduction and elastic intramedullary nails. The patients were assessed clinically and radiologically for two years. The final results were evaluated using the criteria of Flynn et al.Results: Results were assessed for range of motion (ROM), irritation at the distal end of nail, deformity, limb length discrepancies and union. Radiologically union was achieved in a mean time of 9 weeks (6-12 weeks). The most common problem encountered was soft tissue discomfort near knee joint. Excellent results were achieved in 14 patients (67%), successful results in 5 patients (23%) and poor results in 2 patients (10%).Conclusion: It is concluded that paediatrics femoral shaft fractures treated by elastic intramedullary nail gives satisfactory results with minimal complications.