Femoral elastic nailing in the older child: proceed with caution

Six children aged 9-14 years had primary TEN fixation of an isolated femoral diaphyseal fracture. Three of the six patients had major complications, including knee haemarthrosis, loss of position and refracture; two required revision to locked intra-medullary nails without early complication. Two of the six had significant stiffness of the knee requiring manipulation. In the age group 9-14 years, TEN fixation has a significant major complication rate. This needs to be recognised when TEN fixation with other treatment options.