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"Unstable" Pediatric Femoral Shaft Fractures Treated with Flexible Elastic Nails Have Few Complications.

OBJECTIVES
To determine our complication rate in pediatric femoral shaft fractures treated with flexible elastic nailing (FEN) and to determine fracture characteristics that may predict complications.


DESIGN
Retrospective Cohort Study SETTING:: One Level 1 and One Level 2 academic trauma centersPatients/Participants: 101 pediatric femoral shaft fractures treated from 2006 to 2018.


MAIN OUTCOME MEASUREMENT
major and minor complications RESULTS:: 101 femurs met inclusion criteria. Average age was 7y (Range 3-12y). Average weight was 29.0.kg (Range 16-55kg). Average follow-up was 11m (6-36m). 93 patients underwent elective implant removal at our institution. 51/101 (50%) fractures were "unstable" patterns. 93% had implants that filled > 80% of the canal (69 titanium, 32 stainless steel). 17% (18) had cast immobilization. All fractures went on to union. No patient required revision surgery for malunion: 6 had coronal/sagittal malalignment >10, 3 had malrotation >15, none had a leg length inequality >1cm. 3 patients had an unplanned surgery: 2 for prominent implants, and 1 for refracture after a second injury. There were no patient, fracture or treatment characteristics that were predictive of complications or unplanned surgery, including "unstable" fractures (p=0.78).


CONCLUSION
Our study demonstrates that FEN can be safely used in the majority of pediatric femoral shaft fractures, including those previously described as "unstable".


LEVEL OF EVIDENCE
Prognostic Level IV. See Instructions to Authors for a complete description of levels of evidence.