Outcome of Pediatric Femoral Shaft Fractures Treated By Flexible Intramedullary Nailing
Abstract
Background: Diaphyseal fractures of the femur constitute approximately 1.6% of skeletal trauma encountered in the pediatric population. While historical management emphasized prolonged immobilization via traction and spica casting, contemporary practice increasingly favors operative stabilization to accelerate functional recovery and mitigate complications associated with extended recumbency. Among children aged 6–14 years, treatment options include secondary spica application, elastic stable intramedullary nailing (ESIN), submuscular plating, or external fixation for open injuries. This investigation assesses clinical and radiographic outcomes following stainless steel flexible intramedullary nailing for displaced femoral shaft fractures within this age cohort. Methods: This is a retrospective study of 30 patients in the age group of 6-14 years with displaced femoral shaft fractures that were fixed with stainless steel flexible intramedullary nail under fluoroscopy at Narayani hospital Birgunj. Patients were followed clinically and radiologically for six months. The results were evaluated using Flynn’s criteria. Technical difficulties and complications associated with the procedure were also analyzed. Results: Excellent outcomes were achieved in 18 cases (60%) and satisfactory results in 12 (40%), with no poor outcomes. The mean patient age was 9.5 years. Road traffic accidents were the predominant injury mechanism (60%), and middle-third fractures were most common (66.7%). The mean hospital stay was 10 days, and all fractures achieved radiographic union at an average of 10 weeks. Entry-site soft tissue irritation occurred in 5 patients. Three cases demonstrated mild malalignment with an average limb length discrepancy of 0.5 cm; all remained asymptomatic and required no revision surgery Conclusion: Flexible intramedullary nailing provides a minimally invasive, growth-sparing fixation method with a high rate of excellent outcomes and a low complication profile in children aged 6–14 years. Larger multicenter studies with extended follow-up are recommended to further validate long-term functional results.