A child’s bone, whether diaphyseal, metaphyseal, or epiphyseal, varies from adult bone in many ways. A child's bone changes from primarily weak woven bone to stronger lamellar bone by remodeling during childhood. The increasing diameter and bone area contributes to an increase in bone strength. This progressive increase in bone strength helps explain the bimodal distribution of femoral fractures. In early childhood, the femur is relatively fragile and breaks under conditions of load that have been achieved in normal play. Pediatric femoral fractures heal rapidly owing to a biologically active periosteum and abundant vascularity; the formation and subsequent remodeling of callus are also rapid in children who have sustained femoral fractures. For reasons such as minimally invasive surgery, no need for casting, early mobilization and release, and increased concerns about cost-effectiveness, elastic stable intramedullary nailing (ESIN) has become the standard therapy for fractures of the shaft of the femur in children. Because of faster healing, shorter rehabilitation periods, less immobilization, and less psychological impact on the children, the therapy of pediatric femoral fractures has evolved more towards operative intervention in recent decades. Flexible intramedullary nails are simple to use, don't expose the fracture site, and have little side effects

Elastic Stable Intramedullary Nailing, Femoral Fractures, pediatric