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Is there a role for Ender’s nailing of paediatric femoral fractures in a resource-restricted hospital set-up?

Balakumar, Balasubramanian; Natarajan, Mayil V.

Journal of Pediatric Orthopaedics B: March 2013 - Volume 22 - Issue 2 - p 101–105
doi: 10.1097/BPB.0b013e32835c2a33

Paediatric femur fractures are managed with the titanium elastic nail system (TENS) in the 5–16-year age group. TENS is costly and not easily available in public hospitals. This study compares TENS nailing with stainless-steel Ender’s nail fixation of paediatric femur fractures. A retrospective analysis of patient records from 2006 to 2008 yielded 31 children, 5–16 years of age, who underwent flexible nailing for isolated femur fractures. Sixteen children underwent Ender’s nailing and 15 underwent TENS nailing. A significant difference in the coronal plane deformity was found in the TENS nailing group compared with Ender’s nailing. The union time and time to weight bearing were significantly shorter for Ender’s nailing than TENS nailing. The outcome according to Flynn’s criteria was significantly better in the Ender’s nailing group. The results of Ender’s nailing in paediatric femur fractures were comparable with TENS, with a rapid healing time and reduced angular malunion.

Institute of Orthopaedics, Madras Medical College and Government General Hospital, Chennai, Tamil Nadu, India

Correspondence to Balasubramanian Balakumar, Paediatric Orthopaedic Unit, CMC Vellore, 632004 Tamil Nadu, India Tel: +91416 2282172; fax: +91416 2232305; e-mail:

© 2013 Lippincott Williams & Wilkins, Inc.