Titanium Elastic Nailing of Pediatric Femur Fractures

In the last 3 decades, there has been a very strong trend for pediatric orthopedic traumatologists to use some form of fixation to mobilize the school-aged child with a femur fracture. Titanium elastic nailing of pediatric femur fractures is a widely adopted technique that has stood the test of time. Perhaps the most attractive features of this technique for pediatric femur fracture management are the low rate of serious complications and the relatively easy and safe learning curve for most surgeons. There are several pitfalls to the titanium elastic nail technique that should be emphasized. In multiple series, the most common problem is irritation caused by the nails at their entry site. To avoid this most common complication, the nail should not be bent away from the distal femur, and only 1 to 2 cm of nail should be left outside the cortex of the bone. It is essential to follow the principles that were outlined years ago by the French developers of elastic nailing. The nail entry site, nail size and nail length should be symmetric. The nails should be prebent so that they have good cortical contact at the fracture site, as this cortical contact is a key factor in stability. The nails should be used cautiously in length-unstable fractures and in patients older than 12 years of age or who are heavier than 50 kg.