This retrospective study reviews our results with intramedullary nail
fixation of 37 fractures of the femur in 35 skeletally immature patien
ts. Five of these fractures were open. Twenty-two patients (average ag
e 12 + 9 years) were treated with reamed intramedullary nails. Fifteen
patients (average age 9 + 6 years) were treated with nonreamed nails.
All fractures united in 6-12 weeks. There were no infections, delayed
or nonunions, nor were there any incidences of avascular necrosis. Th
ere were very few significant complications. One patient required exci
sion of heterotopic bone to restore hip motion. When surgical treatmen
t of pediatric femur fractures is indicated, we prefer intramedullary
nail fixation (either reamed or nonreamed) depending on age, fracture
pattern (level, degree of comminution), and size of femoral canal. Exp
erience and careful surgical judgment are required to appropriately in
dividualize treatment for these patients.