Ender nails: an alternative for intramedullary fixation of femoral shaft fractures in children and adolescents.

Fixation of femur fractures in children and adolescents is becoming widely accepted because of the lower chance of iatrogenic infection and prohibitive cost of in-hospital traction and spica cast care. Interlocking nails, which have dramatically improved adult femur fracture care, have posed problems, such as injury to the greater trochanteric apophysis and osteonecrosis of the femoral head. We reviewed a series of five stable femoral shaft fractures treated with Ender nails in children from 9 to 17 years of age. No serious complications (eg, leg length inequality) occurred. Follow-up averaged more than 3 years. Complete healing, with return to preinjury activity levels, occurred within 11 weeks on average. Decreased hospitalization, low cost of implants, less potential damage to growth centers, and decreased blood loss and operative time suggest this procedure has merit. Attention to operative technique diminishes previously reported complications attributed to Ender nails.