Trauma: Original ArticleStainless Steel Flexible Intramedullary Fixation of Unstable Femoral Shaft Fractures in ChildrenRathjen, Karl E. MD*; Riccio, Anthony I. MD*; De La Garza, David MD†Author Information From the *Texas Scottish Rite Hospital for Children, Dallas, and †Paris Orthopaedic Clinic, Paris, TX. None of the authors received financial support for this study. Reprints: Karl E. Rathjen, MD, Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219. E-mail: [email protected] Journal of Pediatric Orthopaedics: June 2007 - Volume 27 - Issue 4 - p 432-441 doi: 10.1097/01.bpb.0000271322.48987.46 Buy Metrics Abstract To assess the role of stainless steel flexible intramedullary fixation in unstable pediatric femur fractures, we compared a group of 41 stable (transverse or oblique) fractures with a group of 40 unstable (spiral and/or comminuted) fractures treated with stainless steel (Ender) nails placed through a single lateral insertion. The fractures were followed up until clinical and radiographic union was evident with an average follow-up period of 13 months. All fractures were healed at an average of 1.4 months. No infections or refractures occurred. Although minor radiographic angular deformities and shortening were present in both groups, no patient had a clinically detectable angular deformity. Two patients with stable fracture patterns had 10 to 20 degrees of asymmetry in foot progression angles, and 1 patient with an unstable fracture pattern (Winquist grade IV comminution) had a 3-cm limb length difference at final follow-up. Stainless steel flexible intramedullary fixation is effective for unstable pediatric femur fractures if cortical abutment is present. © 2007 Lippincott Williams & Wilkins, Inc.