title: Flexible intramedullary nailing in paediatric femoral fractures. A report of 73 cases.
abstract: BACKGROUND
  Flexible intramedullary nailing has emerged as an accepted procedure for paediatric femoral fractures. Present indications include all patients with femoral shaft fractures and open physis. Despite its excellent reported results, orthopaedic surgeons remain divided in opinion regarding its usefulness and the best material used for nails. We thus undertook a retrospective study of paediatric femoral fractures treated with titanium or stainless steel flexible nails at our institute with a minimum of 5 years follow up.
  
  
  METHODS
  We included 73 femoral shaft fractures in 69 patients treated with retrograde flexible intramedullary nailing with a minimum follow up of 5 years. Final limb length discrepancy and any angular or rotational deformities were determined.
  
  
  RESULTS
  Mean age at final follow up was 15.5 years (10-21 years). Mean follow up was 7.16 years (5.0-8.6 years). Titanium and stainless steel nails were used in 43 and 30 cases respectively. There were 51 midshaft, 17 proximal, and 5 distal fractures.All fractures united at an average of 11 weeks but asymptomatic malalignment and LLD were seen in 19% and 58% fractures respectively. LLD ranged from -3 cm to 1.5 cm. Other complications included superficial infection(2), proximal migration of nail(3), irritation at nail insertion site(5) and penetration of femoral neck with nail tip(1). There were 59 excellent, 10 satisfactory and 4 poor results.
  
  
  CONCLUSIONS
  Flexible intramedullary nailing is reliable and safe for treating paediatric femoral shaft fractures. It is relatively free of serious complications despite asymptomatic malalignment and LLD in significant percentage of fractures.
authors.affiliation: Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Ramprakash
authors.initials: R
authors.lastname: Lohiya
authors.forename: Vikas
authors.initials: V
authors.lastname: Bachhal
authors.forename: Usman
authors.initials: U
authors.lastname: Khan
authors.forename: Deepak
authors.initials: D
authors.lastname: Kumar
authors.forename: Vishwapriya
authors.initials: V
authors.lastname: Vijayvargiya
authors.forename: Sohan S
authors.initials: SS
authors.lastname: Sankhala
authors.forename: Rakesh
authors.initials: R
authors.lastname: Bhargava
authors.forename: Nipun
authors.initials: N
authors.lastname: Jindal
mesh_terms: D000293:Adolescent; D017760:Bone Malalignment / Q000209:etiology; D001858:Bone Nails; D002648:Child; D002675:Child, Preschool; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D007870:Leg Length Inequality / Q000209:etiology; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D013193:Stainless Steel; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D013193:Stainless Steel; D014025:Titanium