Internal fixation of pediatric shaft femur fractures by titanium elastic nails: clinical and radiological study

Manoharan M., Mahapatra S.


Background: Management of diaphyseal femoral fractures in the pediatric age group is challenging. There has been a demand worldwide for operative fixation.

Methods: Twelve children (7 boys, five girls) aged 6-16 years with diaphyseal femoral fractures (12 fractures, one in each) was stabilized with titanium elastic nail system (TENS). Patients underwent surgery within a week days of their injury. The results were evaluated using Flynn's Scoring system. Identical two nails were used in each fracture.

Results: All 12 patients were available for evaluation and follow-up for a mean duration of 24 months (14-34 months). Radiological union in all cases was seen at a mean duration of 8 weeks. Full weight bearing was possible at a mean duration of 10 weeks (8-12 weeks). The results were excellent in 8 patients (67%) and satisfactory in 4 patients (33%).  Complications that occurred were infection (2 cases), knee joint stiffness (4 cases), angulation <10 degrees (1 case), and shortening less than 10 mm (2 cases).

Conclusions: Intramedullary fixation by TENS is an effective, time-tested treatment of fracture of the femur in patients of the 6-16 years age group.


Intramedullary fixation, Titanium elastic nail, Femoral fracture, Diaphysis

Full Text:



Flynn JM, Skaggs D, Sponseller PD, Ganley TJ, Kay RM, Leitch KK. The Operative Management of Pediatric Fractures of the Lower Extremity. J Bone Joint Surg. 2002;84(12):2288-300.

Heybelly M, Muratli HH, Celeb L, Gulcek S, Bicimoglu A. The Results of Intramedullary Fixation with Titanium Elastic Nails in Children with Femoral Fracture. Acta Orthop Traumatol Turc. 2004;38(3):178-87.

Heinrich SD, Drvaric DM, Darr K, Dean MacEwen G. The Operative Stabilization of Paediatric Diaphyseal Femur Fractures with Flexible Intramedullary Nails: A Prospective Analysis. J Pediatr Orthop. 1994;14(4):501-7.

Herndon WA, Mahnken RF, Yngne DA, Sullivan JA. Management of Femoral Shaft Fractures in the Adolescent. J Pediatr Orthop. 1989;9(1):29-32.

Galpin RD, Willis RB, Sabano N. Intramedullary Nailing of Pediatric Femoral Fractures. J Pediatr Orthop. 1994;14:184-9.

Flynn JM, Luedtke L, Ganley TJ, Pill SG. Titanium Elastic Nails for Pediatric Femur Fractures Lessons from the Learning Curve. Am J Pediatr Orthop. 2002;31(2):71-4.

Buechsenschuetz KE, Mehlman CT, Shaw KJ, Crawford AH, Immerman FB. Femoral Shaft Fractures In Children: Traction and Casting Versus Casting Versus Elastic Stable Intramedullary Nailing. J Trauma. 2002;53(5):914-21.

Ligier JN, Metaizeau JP, Prevot J, Lascombes P. Elastic Stable Intramedullary Nailing of Femoral Shaft Fractures in Children. J Bone Joint Surg. 1988;70(1):74-7.

Narayanan UG, Hyman JE, Wainwright AM, Rang M, Aluman BA. Complications of Elastic Stable Intramedullary Nail Fixation of Paediatric Femoral Fractures and How to Avoid Them. J Pediatric Orthop. 2004;24(4):363-9.