Pediatric humerus fractures: Indications and technique for flexible titanium intramedullary nailing

Background: Most fractures of the humeral diaphysis in children can be treated nonoperatively. In unusual situations surgical stabilization may be required. The purpose of this study is to describe the indications and surgical technique of titanium elastic nail fixation of humeral shaft fractures in children. Methods: Diaphyseal humerus fractures in children have been treated with intramedullary stabilization using titanium elastic nails. Complicating features that required operative stabilization include open fractures, fractures in which reasonable alignment could not be maintained without internal fixation, and patients with ipsilateral forearm fractures (floating elbow) and polytrauma with associated lower extremity fractures necessitating early upper extremity weight bearing. Results: All fractures united without infectious or neurovascular complications. Nail migration requiring nail trimming or early implant removal occurred in a small number of patients and is the most frequent complication of the procedure. Conclusions: In situations in which surgical stabilization of pediatric humeral shaft fractures is necessary, titanium elastic nails provide an effective and simple option, allowing early motion and weight bearing.