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Locked Intramedullary Nailing in the Treatment of Femoral Shaft Fractures in Children Younger than 12 Years of Age: Indications and Preliminary Report of Outcomes

Miller, D. Joshua MD, MBA; Kelly, Derek M. MD; Spence, David D. MD; Beaty, James H. MD; Warner, William C. Jr MD; Sawyer, Jeffrey R. MD

Journal of Pediatric Orthopaedics: December 2012 - Volume 32 - Issue 8 - p 777–780
doi: 10.1097/BPO.0b013e31826bb0ba
Trauma—Lower Extremity

Background: Although flexible intramedullary nailing is a popular treatment option for femoral shaft fractures in juvenile and young adolescent patients, it may not be appropriate in some patients because of patient size and/or fracture configuration.

Methods: Retrospective review over a 3-year period identified 17 skeletally immature patients (18 fractures) with femoral shaft fractures treated with noncannulated rigid locked intramedullary nailing because of a length-unstable fracture or patient overweight or obesity. The 14 males and 3 females had an average age of 10 years at the time of injury (range, 7.6 to 11.9 y). Their average weight was 38.3 kg (range, 22.7 to 52 kg), with an average body mass index of 18.9 (range, 13.9 to 26.9).

Results: All fractures united at an average of 13 weeks, with no osteonecrosis, malalignment, malunion, or hardware failure.

Conclusions: Preliminary results suggest that noncannulated, rigid, locked intramedullary nails can be used safely and effectively for selective fixation of femoral shaft fractures in skeletally immature patients younger than 12 years of age.

Level of Evidence: Level IV.

Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Le Bonheur Children’s Hospital, Memphis, TN

None of the authors received financial support for this study.

The authors declare no conflict of interest.

Reprints: Jeffrey R. Sawyer, MD, 1211 Union Avenue, Suite 510, Memphis, TN 38104. E-mail:;

© 2012 Lippincott Williams & Wilkins, Inc.