1. Failure After Fixation with Flexible IM Nail in Adolescent Femur Shaft Fracture Inje University, Ilsan Paik Hospital Suk Kyu Choo MD

2. Pediatric Femur Shaft Fracture ► Traction and hip spica cast ► Plate and Screws ► External Fixation ► Flexible IM nail

3. Flexible IM Nail ► Elastic titanium nail by Metazear and Lascombes(Nancy Nail) ► Easy technique ► Less invasive ► Early weight bearing, ROM ex. ► No physeal injury, or AVN(Interlocking nail), ► NO refracture(Plate and screws, Ex-Fix) ► Less LLD(?) ► High union rate ► Bar-On et al, JBJS, 1997 ► Oh et al, J Korean Fracture Soc., 2002 ► Yoon et al, J Korean Fracture Soc., 2003 ► Wenger, Rang’s Children’s Fractures, 2005

4. Adolescent Femur Shaft Fracture ► Interlocking IM nail  Trochanteric entry to avoid AVN ► Plate and screws ► Flexible IM nails

5. Flexible IM Nail ► Is it strong enough for heavier adolescents? ► Can it control rotation and angulation in adolescents?

6. Case 1 ► 14 yrs old girl ► Femur shaft fracture with butterfly fragment

7. Case 1

8. Case 2 ► 16 yrs old girl ► Lt femur shaft fracture with butterfly fragment

9. Case 2 ► CR and IF with Flexible IM nail ► LLS and Thigh cuff brace

10. Case 2 ► Thigh cuff brace  angulation ► Required reop with Ex-Fix.

11. Case 3 ► 19 years old girl with femur shaft fracture ► Narrow femoral canal

12. Case 3 ► CR and IF with flexible IM nail ► Anterior bowing and nonunion after 8 month ► Converted to Interlocking nail

13. Femoral Shaft Fractures in Adolescents AuthorsAgeCasesComplicationsAftercare Mann DC 9-1515nonecrutches Ender Nail Fein LH 10-1623 1 angulation crutches Ender Nail Flynn JM 4-1658 1 varus 6 mild malalignment VariableTitaniumNail Yoon YH 4-1128 1 fix. Failure 1 infection BraceTitanium Oh CW 4-1019- LLS 2 wks

14. Femoral Shaft Fractures in Adolescents ► Fixation should be  Stable enough to achieve union  Early motion, early ambulation  Less complications  Easy to apply

15. Titanium Flexible IM nail ► High union rate ► Early motion, ambulation ► No physeal injury vascular injury ► Less invasive ► Easy technique

16. Titanium Flexible IM nail ► Less stable than  Interlocking nails  Ender Nail(Stainless steel nail) ► Good result in children’s fracture ► Special considerations in applying to larger adolescents femur fractures