Flexible Intramedullary Nail Fixation With Supplemental External Fixator for Unstable Pediatric Femur Fractures: A Case Series

Introduction: Flexible intramedullary nail fixation (FIN) has become the preferred mode of treatment for femur fractures in elementary school aged children. One clear limitation of FIN is the inability to control length unstable femur fractures. This case series evaluates radiographic union rates, fracture alignment, and postoperative complications for a novel technique of FIN and adjunct external fixation in length unstable femur fractures. Materials and Methods: A retrospective chart review was performed using current procedural terminology coding to identify 10 pediatric femur fractures utilizing flexible nail fixation with supplemental external fixation in length unstable femur fractures. Electronic medical records were used to obtain demographic information and length of operative time. A picture archiving and communication system was utilized to review radiographs. Results: Combined FIN fixation and supplemental external fixation were used in ten pediatric patients with length unstable femur fractures. The average age at time of injury was 6.4 years (range: 3 to 8 years). The average duration of external fixation was 30 days with no pin site complications including infection or refracture. Average time to union was 54 days with no radiographic loss of reduction. There were no documented intraoperative or postoperative complications. Conclusions: The cases reviewed in this study support that in addition to FIN fixation for unstable pediatric femur fractures, a supplemental external fixator provides a viable option with all fractures obtaining union, acceptable alignment, no loss of reduction, and no postoperative complications. This technique may provide another tool in the orthopedist armamentarium and possibly as an alternative to submuscular plating.