Retrograde titanium elastic nailing in management of length unstable pediatric femoral shaft fracture

Background: Elastic intramedullary nailing is one treatment option which is argued to be ideal stabilization method in various reports, especially in length stable fractures (transverse and short oblique) owing to its load sharing properties and minimum complications. In contrast, results in length unstable fractures are not uniform. Objective: To study the outcome of management of length unstable femur fracture in children with titanium elastic nails. Methods: This was a retrospective study conducted in a tertiary care teaching hospital from August 2013 to July 2015.  For the study purpose we collected records of all consecutive cases of femoral shaft fractures in children from 6 years of age to 15 years. The inclusion criterion were cases of length unstable femoral shaft fracture that were managed with titanium elastic nails and having at least six months of follow up. Results: There were 19 cases fulfilling the inclusion criterion. The mean age was 9±2.357 years. Spiral fracture was seen in 9 cases(47.40%), long oblique fracture was seen in 7 cases(36.80%) and 3 cases (15.80%) were having communition. Fracture united at average 8.42 weeks with standard deviation of 1.26 weeks. The mean follow up was 12.11±3.36 months. There were 14 cases with excellent outcome and 5 cases with satisfactory outcome based on Flynn outcome scoring. Post-operative complications were few. Conclusion: Retrograde elastic nailing is a good option for the management of length unstable paedetric femur fracture when supplemented by slab or cast in initial few weeks. Keywords: Elastic stable intramedullary nailing; Fracture; Femur; Children; Length unstable