Comminuted Femoral Fracture Treated with Locked Enders Nails
Many fixation methods have been proposed for the surgical management of pediatric diaphyseal femur fractures. Implant selection is traditionally based upon the fracture pattern, fracture location, presence of comminution or segmental bone loss, and patient weight and age. In younger children, comminution and length stability of the fracture often dictate implant selection as well as the use of adjunctive postoperative cast immobilization to prevent shortening at the fracture site. Flexible intrameduallary fixation is often considered the “gold standard” for treatment of femoral shaft fractures in children between the ages of 5 and 11 years. Nonetheless, many surgeons prefer alternative methods of fixation when comminution is present due to concerns of shortening across the comminuted segment which can result in limb length inequality and partial nail extrusion with resultant knee pain due to hardware prominence. Because many flexible nails do not have distal interlocking capability to maintain fracture length, submuscular plating, open plating and external fixation are all viable options for restoration of femoral alignment and maintenance of length in comminuted fractures. This case highlights the use of locked flexible intrameduallary stainless steel Enders nails (Smith & Nephew, Memphis, TN) for fixation of a comminuted femoral shaft fracture in a 9-year-old child.