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retrograde flexible intramedullary nails.
80%
36/45
a reamed retrograde femoral nail.
0%
0/45
a reamed antegrade nail starting at the piriformis fossa.
11%
5/45
skeletal traction with a proximal tibial traction pin.
2%
1/45
immediate spica casting.
7%
3/45
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The treatment of choice is stabilization with retrograde flexible intramedullary nails. An antegrade nail starting through the piriformis fossa is contraindicated because the growth plate in the proximal femur is still open. Antegrade nailing through the piriformis fossa in skeletally immature individuals is associated with osteonecrosis of the femoral head. Proximal tibial traction pins in skeletally immature individuals are contraindicated because of the risk of a growth arrest of the anterior portion of the proximal tibial physis with resulting recurvatum deformity of the tibia (although skeletal traction with the pin placed in the distal femur would be acceptable). Immediate spica casting in an 8-year-old child is not acceptable because of the child's size and weight. A retrograde femoral nail would violate the distal femoral physis and result in a large risk of growth arrest.
2.0
(3)
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