RESUMEN
We evaluated use of flexible intramedullary nails in the surgical treatment of femoral shaft fractures in 135 children (138 fractures). Mean age was 9.7 years (range, 2-17 years). Mean follow-up was 15.6 months (range, 6.6-53.5 months). Seventy-two patients were treated with stainless-steel (Ender) nails and 66 with titanium elastic nails. There were 73 midshaft fractures, 48 proximal-third fractures, and 17 distal-third fractures. Fracture patterns were transverse (66), oblique (42), spiral (24), and comminuted (6). There were 16 complications--3 refractures, 2 delayed unions, 3 varus or valgus malalignments, 5 nail-tip irritations, 2 broken interlocking screws (found incidentally on radiographs), and 1 asymptomatic proximal nail migration--for a complication rate of 11.7%. These results demonstrate that use of flexible intramedullary nails in the treatment of femoral shaft fractures in children is successful regardless of patient age, fracture location, or fracture pattern.