Management of paediatric femoral shaft fractures with titanium elastic nails

Abstract

Femoral shaft fractures are the most common major paediatric injuries managed by the orthopaedic surgeon. Management is influenced by associated injuries or multiple trauma, fractures, personality, age and cost. Non-surgical management usually with early spica cast application is preferred in younger children. Surgery is common for the school age child and for patients with high energy trauma. In the older child, traction followed by casting, external fixation, flexible IM nails and plate fixation have specific indications. Potential complications of treatment include shortening, angular or rotational deformity, delayed union, non-union, overgrowth, infection, skin problems and scarring. Risks of surgical management includes refracture after external fixator or plate removal, osteonecrosis after rigid IM nail fixation and soft tissue irrigation caused by ends of flexible nails.