Clinical Details

Clinical and radiological findings:  This is the case of a 9yo boy who suffered a sledding injury - doubled on a sled with his older brother they collided with a tree at speed. The 9yo patient sustained multiple bony injuries including left femur and pelvis. We are discussing the left-sided proximal femoral shaft fracture in this case. As can be identified on the pre-operative plane film imaging, the leg was immobilized pre-hospital in a Thomas traction splint. There is an oblique fracture of the proximal femoral diaphysis with ~100% displacement, moderate angulation and minor non-displaced comminution. A closed and in neurovascularly intact injury we opted for an immediate operative stabilization of the fracture using closed reduction and intramedullary fixation using two 2.5mm ECMES titanium nails. The operation was done supine on the operating table with a freely draped left leg to the pelvic brim. The patient was positioned such on the table that fluoroscopy was not obstructed by metallic elements of the table structure. Medial and lateral supracondylar nail entry points were used and under manual traction, closed reduction was achieved allowing me to traverse the fracture with the ECMES. The two nails were pre-bent distally so as to cause bowing at the level of the fracture. Following introduction of both nails this bowing provided sufficient force across the fracture plane reducing it to near anatomical position.