Global reconstruction of type IIIA open comminuted femoral shaft fracture with segmental bone loss in an 11-year-old girl.

An 11-year-old girl with type IIIA open fracture of the femoral shaft and 4.5 cm bone loss, was treated by global reconstruction using a reamed, interlocking, intramedullary titanium nail, following meticulous primary debridement with pulsed lavage irrigation. The nail entry was carefully chosen at the lateral transtrochanteric point in order to avoid any vascular damage to the head of femur. The osteophilic nature of the titanium nail, in addition to the thick periosteum of the paediatric bone, helped satisfactory union despite a hostile environment. The child had 0-90 degrees flexion of the knee without any extensor lag at the last follow-up. To our knowledge, this is the first case described in the literature that proves the efficacy of nailing for such a fracture.