Our 10-year old son fell during a soccer game with half the opposing team on top of him. He broke his femur in three places. The surgeon used flexible rods down through the bone to hold it in place during healing. Will these rods have to come out later?

The new elastic stable intramedullary nailing (ESIN) system for long bone fractures have revolutionized treatment of femur fractures in children. By placing two curved rods inside the bone, opposing forces are placed on the bone to “reset” it during healing. This saves the family months and months of time in traction and casting. It also saves on the pocketbook in terms of overall costs.

The cost does go up, however, if and when the rods are removed. There’s still much controversy over this point. Not all surgeons agree. Some say to leave them in if they aren’t bothering the child. Others suggest there isn’t enough proof that it’s okay to leave them in. They should be removed to prevent future problems until we know better.

There is some concern that leaving the nails in a child will result in movement or migration of the nails as the child grows. They may end up sticking out of the femur causing pain or even a new fracture.

For now, there’s no right or wrong decision on this. Each surgeon and family must decide based on what seems best for the individual child.