Surgical Treatment of Pediatric Femoral Shaft Fractures
Closed reduction and treatment by immediate spica cast is the preferred method of treatment of femoral shaft fractures in children as old as 4 years of age. Elastic stable intramedullary nailing has proven to be the most advantageous procedure in children between 4 and 14 years of age. Traction methods have a long hospital stay, discomfort, and the risk of overgrowth and malalignment. Plate fixation requires extensive dissection and produces a large scar. Rigid nailing is associated with a small but troublesome risk of avascular head necrosis and valgus deformity as a result of growth plate arrest. External fixation is the preferred method for the rare open and comminuted fractures. Elastic intramedullary fixation with elastic stable intramedullary nailing and Ender nails has a short learning curve for surgeons and a low complication rate. Short hospital stays and low costs of the implants are further advantages. Overgrowth in late controls is lower than that in other types of treatment, with an average of 5 mm.