Objectives: 

To examine the effectiveness and complication rates in age- and size-appropriate patients with either stable or unstable fracture patterns treated with elastic stable intramedullary nailing (ESIN).

Design: 

Retrospective case series.

Setting: 

Academic tertiary care children's hospital.

Patients/Participants: 

This was a consecutive series of 106 preadolescent children with femoral shaft fractures. The mean age of the patients was 8.0 years (range, 4.0–16.0 years).

Intervention: 

All children were treated by retrograde ESIN.

Main Outcome Measures: 

Fractures were categorized as either length stable or unstable. Length stability and complications were assessed. A subset of patients with final full-length, standing x-rays was also evaluated.

Results: 

We analyzed 63 stable and 43 length unstable fractures. The mean age and weight of the patients with stable and unstable fractures were similar. There was no difference in complication rates between groups (χ2(1) = 0.00, P = 0.99). There was no difference (t(96.93) = 0.53, P = 0.59) in femoral shaft length change. Leg length discrepancies as assessed by full-length standing radiographs at follow-up were similar (χ2(2) = 1.52, P = 0.47).

Conclusions: 

Preadolescent children younger than 10 years do not experience increased complications after ESIN of length unstable femur fractures [odds ratio (OR) = 1.68 (0.18–16.87), P = 0.65]. Length unstable femur fractures are not at increased risk of more complications [OR = 0.90 (0.26–2.92), P = 0.87], early femoral shortening [OR = (0.42–2.02), P = 0.85], or leg length discrepancy [OR = (0.13–1.56), P = 0.21] when treated with ESIN.

Level of Evidence: 

Prognostic Level III. See Instructions for Authors for complete description of levels of evidence.