J Am Acad Orthop Surg. September 2012 ; 20 (9) Ying Li, MD and Daniel J. Hedequist, MD Abstract
Currently, surgical management of pediatric femur fracture consists of intramedullary nailing with flexible nails or rigid trochanteric entry nails. Rigid trochanteric entry nails are the implant of choice for femoral fractures in adolescents, whereas titanium elastic nails are popular for the management of length-stable diaphyseal femoral fractures in school-age children. However, higher complication rates have been reported in children with length-unstable diaphyseal femoral fractures treated with titanium elastic nails. These complications may require unplanned surgery. Fracture shortening or angulation can lead to nail prominence or exposure that may require nail shortening or removal. Recently, submuscular plating has been found to be a successful alternative option for management of length-unstable femoral fractures in school-age children. Submuscular plating can also be used in older and/or heavier children who have a femoral canal that is too small to accommodate a rigid intramedullary nail.