Evaluation of Intramedullary Fixation for Pediatric Femoral Shaft Fractures in Developing Countries

Objectives: To report the clinical results after treatment of pediatric femoral shaft fractures with the SIGN Fracture Care International (SIGN) pediatric and standard fin nails. Design: Retrospective review of prospectively collected data. Setting: Sixteen global SIGN centers from 2003 to 2013. Patients/Participants: One hundred twelve pediatric patients who sustained a diaphyseal pediatric femoral shaft fracture. Intervention: Intramedullary fixation with the standard or pediatric SIGN nail. Main Outcome Measurements: Main outcome measurements include clinical and radiographic healing and postoperative complications. Results: The mean age of the pediatric fin patients was 9.4 years (4-15) and 11.2 years (4-18) for the standard fin patients. Painless weight bearing was achieved in 94.7% and 94.5% of the patients at the last follow-up. In total, 23 patients had repeat surgery for the removal of implant. Failure of implant with bending of the nail and/or a valgus or varus deformity (>10 degrees) was noted in 7/57 (12.3%) of the patients treated with the pediatric fin nail, of which 6/7 were >10 years old. Five of these 7 patients were classified as technical errors attributed to inadequate nail diameter, length, or initial malreduction. No complications were noted at any age in the standard fin nail group. Conclusions: In resource-poor settings, SIGN pediatric fin and standard fin nails seem to be an effective treatment option for femoral shaft fractures. In patients with larger canals, the surgeon should consider using the standard fin nail for improved stability and to minimize potential complications. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.