Introduction: The traditional methods for the treatment of femoral shaft fractures of children consists of closed reduction and either spica casting or fixation by external fixator. There are also reports on the treatment of such injuries by open reduction and internal fixation by plate. In the last years the method of minimal invasive fixation of such fractures with elastic nails became popular in children over 6–7 year old. The purpose of this paper is to present our experience with elastic nail fixation of femoral shaft fractures of children.

Material and Methods: We present a series of 43 children aged 3–13 year old, mean age: 6.5y, follow-up 2–4 years, mean 2.5 years) with shaft fractures of the femur. 12 children were under 5 year of age. Seven of them were poly-trauma patients. There were no open fractures. Each patient was treated by closed reduction and percutaneous nail insertion under C-arm imaging intensifier control. Fixation was accomplished by a knee immobilizer alone. Early non-weight-bearing mobilization was encouraged until appearance of callus formation. Subsequently, weight-bearing was encouraged.

Results: The results of all cases were excellent. All fractures were united within 7–14 weeks, with an average of 9 weeks. There were not any cases of femoral fractures through nail insertion. There was no decrease in the range of hip and knee motion. None of the patients had complications such as infection, malalignment or neurovascular injury. There was two cases of bursitis around the tip of the nail in the supracondylar region, which was resolved by early pin removal. Removal of the pins was done 6–9 months following operations.

Conclusions: Closed reduction and minimal invasive fixation of femoral shaft fractures by use of Nancy Nails is safe, simple and useful in children with femoral shaft fractures, even in young children under the age of 5 years, and especially in cases of poly-trauma. This minimally invasive procedure allows for early mobilization with no loss of range of motion or associated complications.

Purpose: Biomechanical studies have shown that fixation by two lateral pins of supracondylar fractures in children provide less stability than crossed pin fixation from lateral and medial sides. However, closed percutaneous medial pin fixation may be associated with ulnar nerve injury. Soft tissue edema or excessive mobility of ulnar nerve may be predisposing factors for iatrogenic ulnar nerve injury. We present our experience with the use of nerve stimulator in preventing such complications during surgery.

Material and Methods: During the last two years 22 children with supracondylar fractures (20- extension type; 2- flexion type) underwent surgery by closed reduction and percutaneous crossed KW fixation. The average age was 5.3 years (range 3–9 years). Detection of the ulnar nerve location was made possible by continuous intraoperative use of nerve stimulator, connected to the medial pin during its insertion. In 4/22 Pts irritation of ulnar nerve during pin insertion was observed by the appearance of clear contractions of forearm and hand muscles, and therefore, the location of the medial pin was immediately changed.

Results: In all cases anatomic reduction was achieved. No cases of nerve or vascular injury were observed. No cases of secondary fracture displacement were noted.

Conclusions: Based on this study it seems that the use of intraoperative nerve stimulator, during percutaneous crossed pin fixation of supracondylar fractures in children, may assist in localizing the nerve and prevent its injury during medial pin insertion. Changes in original setting of the standard anesthesiology nerve stimulator may be performed easily in order to allow such monitoring. The use of nerve stimulator during such procedures is very simple, even in cases of emergency. Monitoring of ulnar nerve by nerve stimulator is reliable and enables safe pin placement, decreasing the risk of nerve injury.