Complications of pediatric femur fractures treated with titanium elastic nails: a comparison of fracture types.

The purpose of this study was to analyze complications seen in children with femur fractures stabilized with titanium elastic nails, comparing their use in stable and unstable fracture patterns. A retrospective review was performed on 39 consecutive children with femur fractures treated with titanium elastic nails. Patients with comminuted or long oblique fractures were classified as having "length-unstable" fractures. Patients were analyzed qualitatively for any predictive factors or treatment variables that increased the risk of complications. There were 24 patients with complications (62%). Eight patients (21%) underwent unplanned surgery prior to complete fracture union. Six of the eight requiring unplanned surgery were treated for "length-unstable" fractures. The complications that required unplanned surgery for either prominent nails or loss of reduction occurred more commonly in unstable non-transverse fracture patterns. The authors conclude that in patients with "length-unstable" femur fractures, consideration should be given to methods of treatment other than titanium flexible intramedullary nails.