Adolescent femoral diaphyseal fracture nonunion

Femoral diaphyseal fractures comprise approximately 1.4-1.7% of all pediatric fractures and are the most common pediatric orthopaedic injury requiring hospitalization. Over the last 2 decades there has been a shift from conservative treatment in children to options of external fixation, submuscular plating, rigid locked intramedullary nailing, and flexible elastic nailing, the latter of which has emerged as a treatment of choice. Titanium elastic intramedullary nailing is minimally invasive, provides adequate stability, has good reported outcomes, and low rates of complications. However, nonunion, although rare, can occur. This paper examines the complication of the rare nonunion after titanium elastic intramedullary nailing of a femoral diaphyseal fracture, using a case illustration.