Femoral Shaft Fracture: Flexible Intramedullary Nails
A 6-year-old female sustained a right transverse mid-shaft femur fracture after being hit by a golf cart. Due to her skeletal immaturity and the transverse fracture pattern, flexible intramedullary nailing was chosen to stabilize the fracture. Flexible intramedullary nailing is ideal for patients who are too large for immobilization alone, but are skeletally immature, where drilling through the greater trochanteric apophysis would risk injury to the blood supply of the femoral head (< age 10). Flexible intramedullary nails can be considered in length-stable fracture patterns in patients less than 100 lb (45 kg) with open growth plates. Postoperatively, patients can be managed with a knee immobilizer or no immobilization depending on the stability of fracture fixation. The knee immobilizer can be removed to allow early range of motion of the hip and knee. Hardware removal is often recommended, but it is not required.
References and Suggested Readings
- Gholve A, Flynn JM (2011) Femur fracture: flexible intramedullary nailing. In: Kocher M, Millis M (eds) Operative techniques: pediatric orthopedic surgery, 1st edn. Philadelphia, pp 241–252Google Scholar