Twenty-seven adolescents with 29 femoral shaft fractures, between the
ages of 10 and 16 years, were treated with closed flexible Ender intra
medullary nailing from 1989 to 1992 in our clinic. In one patient who
had a fracture of the distal third of the femoral shaft, the nail was
inserted proximal to distal (antegrade nailing). In the other patients
, the nails were inserted distal to proximal (retrograde nailing). Cli
nical and radiological follow up averaged 32 months (18-56 months). Ho
spitalization averaged 15 days (7-28 days). All fractures healed with
one significant leg length discrepancy of 1.7 cm in a patient who had
developed osteomyelitis. There was no significant angulation or malrot
ation, All patients had a normal gait and were able to participate in
full activities. There was one deep wound infection in a patient with
an open fracture of the femoral shaft, There were no non-unions, delay
ed-unions or psychological complications. For this age group, this tre
atment of femoral shaft fracture should be considered owing to the fun
ctional recovery with low morbidity and cost, providing early ambulati
on, early discharge from hospital and early return to school.