This technique has been used successfully at King Khalid hospital, Najran, Saudi Arabia since 1995.
This prospective study was prompted by a review of earlier reports by Shakeel , Salem Al Zahrani , and Ligier and Metazieau .
Fracture treatment in children relies on rapid healing and spontaneous correction of angulated fractures; therefore most of the diaphyseal fractures can be treated by plaster alone. Operative treatment of children's fractures is often looked at critically .
Conventional treatment of femoral shaft fractures in children is by traction followed by a hip spica or a Thomas' splint. Conservative treatment of femoral shaft fractures gives good results in children under 5 years of age. But above that age, all such fractures cannot be treated by conservative methods. There is a possibility of loss of reduction and malunion. Plaster immobilisation has its own complications like pressure sores, nerve palsies, soiling of the skin and the plaster, breakage of the plaster, joint stiffness. The child is immobilised and needs an attendant for personal care.
Reeves et al  reported that the cost of non-operative treatment is 40 % higher than operative treatment.
In the last few decades, the trend worldwide has been towards some form of fixation for children's fractures, especially the femoral shaft, and the indications for operative management have been widened.
Rush  used the intramedullary rods of his design. Intramedullary nailing was made popular by Ender and Simon-Weidner in Europe , and by Pankovitch in the United States .
Beaty, Austin and Canale  studied the preliminary results and complications of interlocking intramedullary nailing of femoral shaft fractures in adolescents.
Gonzalez and Herranz recommend the avoidance of rigid intramedullary nails introduced through the piriformis fossa in children less than 13 years of age. Antegrade intramedullary nailing through the piriformis fossa may cause coxa valga, epiphyseodesis of greater trochanter, thinning of the femoral neck because of damage to the growth plate.
Saxer advises the introduction of intramedullary Kuntscher nail through the sub-trochanteric zone or the use of plate and screw.
External fixation has been advocated by Aronson and Tursky. They reported angular deformity and shortening of more than 13 mm in proximal third femoral shaft fractures treated by conservative means. External fixation has its own complications; pin track infection and refracture[9, 18, 19]. Also, the child has to accommodate an external device.
Compression plating was used by Van Neikerk , Ward  and Hansen . The disadvantages are the risk of infection, large soft tissue dissection, delayed union, limb length disparity, another large exposure to remove the implants [10, 11]. The other disadvantages are periosteal stripping, evacuation of fracture haematoma and blood loss. Tarek Mirdad  reported blood loss requiring blood transfusion in 41 % of children treated by compression plating. Also, a period of 3–4 weeks of protected weight bearing is recommended after removal of plate and screws.
Ligier and Metaizeau have successfully treated 123 femoral shaft fractures in children by Elastic Stable Intramedullary Nailing (ESIN) .
Pradeep Kumar , Shakeel  and Zahrani  recommend the efficacy of Kirschner wires for flexible intramedullary nailing of femoral shaft fractures in children. Shakeel reports reduced psychological trauma on the child and the parents .