Comminuted Femoral Fracture Treated with Locked Enders Nails

Living reference work entry


Many fixation methods have been proposed for the surgical management of pediatric diaphyseal femur fractures. Implant selection is traditionally based upon the fracture pattern, fracture location, presence of comminution or segmental bone loss, and patient weight and age. In younger children, comminution and length stability of the fracture often dictate implant selection as well as the use of adjunctive postoperative cast immobilization to prevent shortening at the fracture site. Flexible intrameduallary fixation is often considered the “gold standard” for treatment of femoral shaft fractures in children between the ages of 5 and 11 years. Nonetheless, many surgeons prefer alternative methods of fixation when comminution is present due to concerns of shortening across the comminuted segment which can result in limb length inequality and partial nail extrusion with resultant knee pain due to hardware prominence. Because many flexible nails do not have distal interlocking capability to maintain fracture length, submuscular plating, open plating and external fixation are all viable options for restoration of femoral alignment and maintenance of length in comminuted fractures. This case highlights the use of locked flexible intrameduallary stainless steel Enders nails (Smith & Nephew, Memphis, TN) for fixation of a comminuted femoral shaft fracture in a 9-year-old child.


Femoral Shaft Fractures Pediatric Diaphyseal Femur Fractures Distal Interlocking Fracture Site Length-unstable Fractures 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References and Suggested Reading

  1. Cramer KE, Paul Tornetta III, Spero CR, Alter S, Miraliakbar H, Teefey J (2000) Ender rod fixation of femoral shaft fractures in children. Clin Orthop Relat Res 376:119–123CrossRefGoogle Scholar
  2. Ellis HB, Ho CA, Podeszwa DA, Wilson PL (2011) A comparison of locked versus nonlocked enders rods for length unstable pediatric femoral shaft fractures. J Pediatr Orthop 31(8):825–833CrossRefPubMedGoogle Scholar
  3. Kocher MS (2010) American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of pediatric diaphyseal femur fracture. J Bone Joint Surg Am 92(8):1790. CrossRefPubMedGoogle Scholar
  4. Linhart WE, Roposch A (1999) Elastic stable intramedullary nailing for unstable femoral fractures in children: preliminary results of a new method. J Trauma 47(2):372–378CrossRefPubMedGoogle Scholar

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryShriners Hospital for ChildrenSalt LakeUSA
  2. 2.Department of OrthopaedicsTexas Scottish Rite HospitalDallasUSA

Section editors and affiliations

  • Eric D. Shirley
    • 1
  1. 1.Pediatric Orthopaedic AssociatesAltantaUSA

Personalised recommendations