Purpose: Femur fractures in children have a significant impact on families and the hospital system in Canada. There are several methods for treating femur fractures in children. The purpose of this study was to determine which of two techniques: Flexible Femoral Nailing (FFN) or Trochanteric Antegrade Nail (TAN), are the most safe and efficacious.

Method: Hospital charts for all paediatric femur fracture patients between 1984 and 2006 treated with either FFN or TAN were reviewed. Demographic, clinical, radiographic and hospital stay data were collected and analyzed.

Results: Ninety-seven children (100 fractures) were reviewed. The average age of patients was 11.9 years (SD = 4.4). Fifty-two fractures were treated with FFN and 48 fractures were treated with TAN. No serious complications were encountered in either group, including AVN. Minor complications in the FFN group included three patients with mal-alignment, and one with shortening of the limb. Two patients in the TAN group had shortening of the fractured limb. No radiographic differences were noted. The median length of stay for patients treated with FFN was 3 days (IQR = 2) and for patients treated with TAN was 3 days (IQR = 2). Overall, there were no significant differences in the clinical findings (including complications), radiographic evaluations, or length of stay between FFN and TAN cohorts. The only significant difference between the groups was length of surgical time (p value < 0.001).

Conclusion: TAN is as safe and efficacious a treatment as FFN but requires addition operating room time, and hence hospital resources.