Enhancing Stability of Pediatric Femoral Fractures Treated with Elastic Nail Using an External Fixator

<b>Background</b>: Diaphyseal femoral fractures in children older than 5 years and before adolescence are usually treated surgically. The literature describes several surgical techniques; however, we present an additional minimally invasive technique that combines the use of elastic intramedullary nails and a uniplanar external fixator as an optional solution for managing more complex cases. <b>Method</b>: This was a retrospective review of four children aged 9-12 years who suffered from unstable diaphyseal femoral fractures and were admitted to our institution. <b>Results</b>: We treated four children between the years 2021 and 2023. All patients underwent closed reduction of their fractures and fixation with an elastic intramedullary nail and an external fixator. Full radiographic fracture healing with acceptable alignment was achieved in all patients. The minimum clinical follow-up was 1.5 years. No major complications were observed, and all patients achieved full clinical recovery as well as proper limb alignment and length. <b>Conclusions</b>: Fixation of complex diaphyseal femoral fractures using a combination of internal and external fixation is a simple technique that avoids the need for extensive soft tissue exposure while also promoting fracture stability and maintenance of bone length and rotation. This method can be incorporated into the armamentarium of orthopedic surgeons as an additional solution for addressing more challenging cases.