{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T11:53:21Z","timestamp":1772798001876,"version":"3.50.1"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:sec>\n            <jats:title>Objectives:<\/jats:title>\n            <jats:p>To determine our complication rate in pediatric femoral shaft fractures treated with flexible elastic nailing and to determine fracture characteristics that may predict complications.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Retrospective cohort study.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>One Level 1 and One Level 2 academic trauma centers.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patients\/Participants:<\/jats:title>\n            <jats:p>One hundred one pediatric femoral shaft fractures treated from 2006 to 2018.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Main Outcome Measurement:<\/jats:title>\n            <jats:p>Major and minor complications.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>One hundred one femurs met inclusion criteria. The average age was 7 years (range 3\u201312 years). The average weight was 29.0 kg (range 16\u201355 kg). The average follow-up was 11 months (6\u201336 months). Ninety-three patients underwent elective implant removal at our institution. Fifty-one of the 101 (50%) fractures were \u201cunstable\u201d patterns. Ninety-three percent had implants that filled &gt;80% of the canal (69 titanium and 32 stainless steel). Seventeen percent (18) had cast immobilization. All fractures went on to union. No patient required revision surgery for malunion as follows: 6 had coronal\/sagittal malalignment &gt;10 degrees, 3 had malrotation &gt;15 degrees, and none had a leg length inequality &gt;1 cm. Three patients had an unplanned surgery as follows: 2 for prominent implants and 1 for refracture after a second injury. There were no patient, fracture, or treatment characteristics that were predictive of complications or unplanned surgery, including \u201cunstable\u201d fractures (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.78).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion:<\/jats:title>\n            <jats:p>Our study demonstrates that flexible elastic nailing can be safely used in most pediatric femoral shaft fractures, including those previously described as \u201cunstable.\u201d<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of Evidence:<\/jats:title>\n            <jats:p>Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000001886","type":"journal-article","created":{"date-parts":[[2020,10,15]],"date-time":"2020-10-15T21:32:32Z","timestamp":1602797552000},"page":"e56-e60","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":10,"title":["\u201cUnstable\u201d Pediatric Femoral Shaft Fractures Treated With Flexible Elastic Nails Have Few Complications"],"prefix":"10.1097","volume":"35","author":[{"given":"Omar","family":"Atassi","sequence":"first","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip B.","family":"Fontenot","sequence":"additional","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and"},{"name":"Department of Orthopaedic Surgery, University of South Florida, Tampa, FL."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gennadiy","family":"Busel","sequence":"additional","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guadalupe","family":"De La Fuente","sequence":"additional","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Donohue","sequence":"additional","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and"},{"name":"Department of Orthopaedic Surgery, University of South Florida, Tampa, FL."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Maxson","sequence":"additional","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and"},{"name":"Department of Orthopaedic Surgery, University of South Florida, Tampa, FL."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anjan R.","family":"Shah","sequence":"additional","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and"},{"name":"Department of Orthopaedic Surgery, University of South Florida, Tampa, FL."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David T.","family":"Watson","sequence":"additional","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and"},{"name":"Department of Orthopaedic Surgery, University of South Florida, Tampa, FL."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony F.","family":"Infante","sequence":"additional","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and"},{"name":"Department of Orthopaedic Surgery, University of South Florida, Tampa, FL."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katheryne","family":"Downes","sequence":"additional","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roy W.","family":"Sanders","sequence":"additional","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and"},{"name":"Department of Orthopaedic Surgery, University of South Florida, Tampa, FL."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hassan R.","family":"Mir","sequence":"additional","affiliation":[{"name":"Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and"},{"name":"Department of Orthopaedic Surgery, University of South Florida, Tampa, FL."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-20250614","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1302\/0301-620X.70B1.3339064","article-title":"Elastic stable intramedullary nailing of femoral shaft fractures in children","volume":"70","author":"Ligier","year":"1988","journal-title":"J Bone Joint Surg Br."},{"key":"R2-20250614","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1302\/0301-620X.88B10.17517","article-title":"Titanium elastic nailing of fractures of the femur in children. 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