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Preliminary Report

Pediatric Femur Fractures

Single Incision Intramedullary Stabilization Technique

Knedel, Matthew MD*; Gallego, Edward W. MD*; Gerardi, Joseph DO*; Husak, Lisa MPH; Altebarmakian, Maria BS

doi: 10.1097/BPO.0000000000000369
Trauma Lower Extremity

Background: Pediatric femoral shaft fractures are common injuries that have seen a trend toward surgical stabilization. Traditionally these fractures have been stabilized with flexible intramedullary nails performed through a 2-incision technique. We proposed that a single incision technique would offer equivalent outcomes with the potential for improved cosmesis and a reduced infection risk.

Methods: A retrospective review was performed of 112 consecutive cases of pediatric femoral shaft fractures, 66 cases were excluded, leaving 23 cases utilizing the single incision technique and 23 utilizing the standard 2-incision technique. Electronic medical records were then reviewed for demographic information, and a PAC system was employed to classify the fractures according to the AO classification and determine the time to fracture union.

Results: No significant difference was found in fracture healing times with a mean union time of 62.4 and 50.3 days in the single and double incision groups, respectively (P=0.38). One complication of superficial infection was noted in the 2-incision group; however, this was not statistically significant, and no malunions or nonunions were detected in either group.

Conclusions: A single incision technique for intramedullary stabilization of pediatric femoral shaft fractures is a viable option with an equivalent time to fracture union and no observed difference in the complication rate. Furthermore, the technique may offer benefits with regard to infection risk and cosmesis.

Level of Evidence: Level III.

*Children’s Hospital Central California, UCSF Fresno, Department of Orthopaedic Surgery

UCSF Fresno, Department of Orthopaedic Surgery, Fresno, CA

No funding or other sources of support to disclose.

The authors declare no conflicts of interest.

Reprints: Matthew Knedel, MD, UCSF Fresno, Department of Orthopaedic Surgery, 2823 Fresno Street, 7th Floor, Fresno, CA 93721. E-mail:

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