Pediatric femoral fractures are typically treated with age-dependent protocols that consider both the growth and remodeling potential of the femur and patient characteristics such as weight and socioeconomic environment of the child. Although it is generally agreed that children five years of age or younger can be adequately managed with a spica cast for length-stable femoral fractures, the range of treatment options for patients between the ages of five years to skeletal maturity span the gamut of flexible nailing, submuscular plating, external fixation, and trochanteric entry rigid intramedullary nailing. Piriformis entry rigid nails are generally shunned in pediatric practice because of a clear association with osteonecrosis.

Trochanteric entry rigid intramedullary nailing is advantageous in treating pediatric femoral shaft fractures in several respects. First, when compared with flexible nails, proximal and distal interlocking allows unmatched length and rotational control of complex injuries. Second, this load-sharing device does not fear the obese child. Finally, the average orthopaedic surgeon is well trained in this technique and can offer reproducible results. For a femoral fracture in a child nearing skeletal maturity, the choice of rigid intramedullary nail fixation generates no particular debate. However, great concern exists for children with the approximate ages of five to fourteen years. Use of a trochanteric entry device in a child with substantial growth potential can theoretically lead to subsequent growth disturbance of the proximal femur and/or osteonecrosis of the femoral head. For every orthopaedist involved in the treatment of pediatric femoral fractures, the questions that arise with the use of this implant are whether the technique is generally safe and what the youngest patient age is at which a trochanteric entry rigid nail can be used.