To investigate the clinical results of Bouquet technique [multiple elastic stable intramedullary nails (ESIN)] in the treatment of unstable pediatric femoral shaft fractures.

From August 2016 to October 2019, 25 pediatric patients (26 sides) with unstable femoral shaft fracture were treated with Bouquet technique at Department of Pediatric Orthopedics, The Second Fuzhou Hospital Affiliated to Xiamen University. They were 17 boys and 8 girls, with a mean age of 7.8 years at injury (from 5 to 11 years). Their body weight ranged from 23 kg to 62 kg, with an average of 36.3 kg. Long oblique fractures happened in 6 cases (6 sides) and comminuted fractures in 19 cases (20 sides). Ten cases (11 sides) were fixated with 3 ESINs (type 3A) and 15 cases (15 sides) with 4 ESINs (type 4A in 6 cases and type 2A+2B in 9 cases). The multiple ESINs were inserted from the medial and lateral cortex of the distal femur through the fracture sides until the head ends of the nails were distributed evenly at the proximal femur. Recorded were the fracture healing time, complications, fracture reduction quality and hip function at the last follow-up.

All the 25 patients were followed up for 18 to 27 months (mean, 22.4 months). Their fractures got united after 4 to 8 weeks (mean, 6.3 weeks). One case presented with femoral overgrowth of 1.1 cm and another case with nail tail irritation. Follow-ups revealed that none of the patients had such complications as incision infection, limited joint movement, nonunion or delayed fracture union. The limb alignment recovered well with no angulation, shortening or rotational deformity. At the last follow-up, according to the efficacy evaluation system for intramedullary nails by Flynn et al., the quality of reduction of femoral shaft fractures was assessed as excellent in 24 sides and as good in 2 sides, giving an excellent and good rate of 100% (26/26). According to the hip Harris scoring system, the hip function was assessed as excellent in all the 26 sides, giving an excellent rate of 100% (26/26).

Bouquet technique is safe and effective in the treatment of unstable pediatric femoral shaft fractures, leading to fine clinical results.

Femoral fractures; Fracture fixation, intramedullary; Bone nails; Child