Modern Trends in Internal Fixation of Femoral Shaft Fractures in Children. A Critical Review

Elastic intramedullary (IM) devices, which avoid the physeal region like Nancy and Ender nails do, can be used in children younger than even 4 years without compromising the trochanter physis or risking an avascular necrosis. Intramedullary fixation of femoral shaft fractures leads to satisfactory results of alignment and union. Prerequisites for intramedullary closed nailing are a traction table, especially for older children and adolescents, and an image intensifer. Interlocking IM, Ender, and Nancy nails all have the equal advantage of early weight bearing and reduced hospitalization time compared with traction and cast management. Küntscher or interlocking nails should only be used in adolescents close to the end of growth to avoid growth arrest of the trochanterocervical physis. Küntscher nails and interlocking IM nails are both associated with the small but troublesome risk of avascular necrosis. Ender and Nancy nails, with retrograde or antegrade pinning, have a low complication rate and a short learning curve for surgeons. Overgrowth in late controls after IM rodding of shaft fractures is about the same as the other types of treatment with an average overgrowth of 7 mm. Short hospital stay for children with IM nails reduces cost of treatment to about one half compared with in-hospital traction and cast management.