Malunion following flexible intramedullary nails for tibial and femoral fractures in adolescents

Purpose Flexible intramedullary nails (FIN) are increasingly used in the management of paediatric tibial and femoral fractures. Concerns have recently been raised regarding the use of FIN in older children. The aim of this study was to determine how effective FIN is in treating tibial and femoral fractures in adolescents. Methods Patients aged 11 years or older undergoing FIN for tibial and femoral fractures between 2003 and 2009 were identified. Radiographs and case notes were reviewed to identify complications. Results Thirty-five consecutive adolescent patients underwent FIN for tibial (n = 21) and femoral fractures (n = 15), with a mean age of 12.9 years. The mean radiographic follow up was 29 weeks. Sixty percent (60%, n = 9) and 38% (n = 9) of femoral and tibial fractures, respectively, malunited. Fracture severity was associated with increased malunion for both tibial and femoral fractures (P = 0.046 and P = 0.044, respectively). Two femoral fractures took longer than 20 weeks to unite and seven tibial fractures took longer than 16 weeks to unite. Conclusion The higher than expected rates of malunion and delayed union in this study suggest that other treatments should be considered when treating adolescents with unstable tibial or femoral fractures.