Luau Limbo and the Age for Rigid Nailing of Pediatric Femoral Fractures: How Low Can You Go? Commentary on an article by Samuel N. Crosby Jr., MD, et al.: "Twenty-Year Experience with Rigid Intramedullary Nailing of Femoral Shaft Fractures in Skeletally Immature Patients".

Abstract

Pediatric femoral fractures are typically treated with age-dependent protocols that consider both the growth and remodeling potential of the femur and patient characteristics such as weight and socioeconomic environment of the child. Although it is generally agreed that children five years of age or younger can be adequately managed with a spica cast for length-stable femoral fractures, the range of treatment options for patients between the ages of five years to skeletal maturity span the gamut of flexible nailing, submuscular plating, external fixation, and trochanteric entry rigid intramedullary nailing. Piriformis entry rigid nails are generally shunned in pediatric practice because of a clear association with osteonecrosis1. Trochanteric entry rigid intramedullary nailing is advantageous in treating pediatric femoral shaft fractures in several respects. First, when compared with flexible nails, proximal and distal interlocking allows unmatched length and rotational control of complex injuries. Second, this load-sharing device does not fear the obese child2. Finally, the average orthopaedic surgeon is well trained in this technique and can offer reproducible results. For a femoral fracture in a child nearing skeletal maturity, the choice of rigid intramedullary nail fixation generates no particular debate. However, great concern exists for children with the …