title: Titanium elastic nailing in diaphyseal femoral fractures of children below six years of age.
abstract: OBJECTIVE
  To report the clinical and radiographic results of titanium elastic nail (TEN) in diaphyseal femoral fractures of children below age of six years.
  
  
  METHODS
  A retrospective analysis of 27 diaphyseal femoral fractures in children younger than six years treated with TEN between 2005 and 2015 was conducted. Patients were immobilized in a cast for 5 wk and the nails were removed from 6 to 12 wk after surgery. Twenty-four cases were clinically and radiographically re-evaluated using the Flynn's scoring criteria, focusing on: Limb length discrepancy, rotational deformity, angulation, hip and knee range of motion (ROM), functional status, complications, and parent's satisfaction.
  
  
  RESULTS
  Sixteen males and eight females with a mean age of 3.2 years at the time of treatment were re-evaluated at an average follow-up of 58.9 mo. No cases of delayed union were observed. The mean limb lengthening was 0.3 cm. Four cases experienced limb lengthening greater than 1 cm and always minor than 2 cm. Twelve point five percent of the cases showed an angulation < 10°. Complete functional recovery (hip and knee ROM, ability to run and jump on the operated limb) occurred in 95.7% of cases. Complications included two cases of superficial infection of the TEN entry point, one case of refracture following a new trauma, and one TEN mobilization. According to the Flynn's scoring criteria, excellent results were obtained in 79.2% of patients and satisfactory results in the remaining 20.8%, with an average parent's satisfaction level of 9.1/10.
  
  
  CONCLUSIONS
  TEN is as a safe, mini-invasive and surgeon-friendly technique and, considering specific inclusion criteria, it represents a useful and efficacy option for the treatment of diaphyseal femoral fractures even in patients younger than six years of age.
authors.affiliation: Fabrizio Donati, Giuseppe Mazzitelli, Marco Lillo, Amerigo Menghi, Carla Conti, Antonio Valassina, Emanuele Marzetti, Giulio Maccauro, Orthopedic and Traumatology Institute, Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Donati
authors.affiliation: Fabrizio Donati, Giuseppe Mazzitelli, Marco Lillo, Amerigo Menghi, Carla Conti, Antonio Valassina, Emanuele Marzetti, Giulio Maccauro, Orthopedic and Traumatology Institute, Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mazzitelli
authors.affiliation: Fabrizio Donati, Giuseppe Mazzitelli, Marco Lillo, Amerigo Menghi, Carla Conti, Antonio Valassina, Emanuele Marzetti, Giulio Maccauro, Orthopedic and Traumatology Institute, Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Lillo
authors.affiliation: Fabrizio Donati, Giuseppe Mazzitelli, Marco Lillo, Amerigo Menghi, Carla Conti, Antonio Valassina, Emanuele Marzetti, Giulio Maccauro, Orthopedic and Traumatology Institute, Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Amerigo
authors.initials: A
authors.lastname: Menghi
authors.affiliation: Fabrizio Donati, Giuseppe Mazzitelli, Marco Lillo, Amerigo Menghi, Carla Conti, Antonio Valassina, Emanuele Marzetti, Giulio Maccauro, Orthopedic and Traumatology Institute, Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Conti
authors.affiliation: Fabrizio Donati, Giuseppe Mazzitelli, Marco Lillo, Amerigo Menghi, Carla Conti, Antonio Valassina, Emanuele Marzetti, Giulio Maccauro, Orthopedic and Traumatology Institute, Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Valassina
authors.affiliation: Fabrizio Donati, Giuseppe Mazzitelli, Marco Lillo, Amerigo Menghi, Carla Conti, Antonio Valassina, Emanuele Marzetti, Giulio Maccauro, Orthopedic and Traumatology Institute, Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Marzetti
authors.affiliation: Fabrizio Donati, Giuseppe Mazzitelli, Marco Lillo, Amerigo Menghi, Carla Conti, Antonio Valassina, Emanuele Marzetti, Giulio Maccauro, Orthopedic and Traumatology Institute, Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Maccauro
keywords: Elastic stable intramedullary nailing; Femural shaft; Pediatric femoral fractures; Surgical treatment; Titanium elastic nailing