Management of pediatric femoral shaft fractures with long intramedullary kirshner wires

I ntramedullary titanium elastic nails (TEN) have been used for treatment of the pediatric patients with femoral shaft fractures in the last 15 20 years. They are load bearing devices and are flexible to allow bending. Small incisions are required for introduction of these nails and they are easy to remove. High cost is a disadvantage. However in the developing countries, where cost and affordability are a concern it is not feasible to use titanium elastic nails. In my centre, the titanium rigid intramedullary nails were available but not the elastic and flexible nails. Risk of avascular necrosis of the femoral head exists when done in skeletally immature children. Entry point at pyriformis fossa may injure the lateral epiphyseal vessels leading to avascular necrosis of the femoral head, whereas entry point at the trochanteric tip may cause damage to the trochanteric physis with advancing growth of the child. Rigid intramedullary nailing is probably best reserved for children over 12 years of age. Due to the unavailability of titanium nails, we used stainless steel Kirshner wires as an intramedullary device in the treatment of 14 children 11 boys and three girls (age 5 12) admitted to Sebha medical Centre, Sebha, Libya, between September 2009 and December 2010 with a diaphyseal fracture of the femur. All were closed fractures with no neurovascular compromise. Eleven children sustained motor vehicle accidents and three sustained falls from height. Two patients also had Salter Harris type 2 injury of distal radius. Fracture pattern was transverse in eight, spiral oblique in five and comminuted in one. Nine fractures were middle