Length unstable femoral fractures: A misnomer?

Figure 1 Length unstable femur fracture treated with flexible intramedullary nailing. Seven-year-old male, spiral fracture, treatment: closed reduction and flexible intramedullary nailing of the right femur using two 4.0-mm titanium elastic nails, hardware removal (symptomatic).

Figure 2 The treatment of a pediatric diaphyseal femoral fracture. Six-year-old male, large comminution, open reduction and external fixation, monolateral external fixation, transitioned to spica cast after 6 wk due to pin site infection.

Figure 3 Another pediatric length unstable spiral fracture, but instead of flexible intramedullary nailing. Eight-year-old male, spiral fracture treated with submuscular plating, fairly significant keloid scars.