Abstract
Introduction: Femoral shaft fractures are among the most common pediatric injury, which have the highest incidence among other pediatric fractures, and treatment of them carries a lot of controversies. Aim of the study: To compare the outcome of fixation of femoral shaft fracture by elastic nail with Spica cast. Patient and method: This prospective comparative study was carried out in Sulaimani Teaching Hospital, in the period from the 10th of December 2011 to the 10th of June 2012, for two groups of children whose ages were between 4 - 12 years (average 6.61 years), sustained traumatic femoral shaft fractures with follow-up period of about 6 months. The first group was consisting of 30 children treated by Elastic Intramedullary Nail, while the second group was consisted of 30 children treated by hip Spica. The selection was made on random bases. Results: Age range was between 4 - 12 years and showed male predominance in both groups with ratio of about 2:1 while fracture site showed predominance of the midshaft pattern in both groups. This study showed highly significant deference (P value of 0.001) between the two groups (Spica group of 3 days versus Nail group median of rate 4.5 days) in the admission period. Our sample showed shortening of about 2 cm in 2 case in the Nail group (6.7%) versus 6 cases (20%) in Spica group. We reported 4 cases of wound infection (13.3%) and 4 cases of pin site irritation (13.3%) in nail group. A higher rate of malunion was observed in the Spica group (10 cases more than 10° angulation in coronal plane) while the Nail group reported 2 case more than 10° in coronal plane. The mean operative time for Nail group was 55 minutes while in Spica group was 30 minutes. We reported shorter time to start mobilization and walking with support or independently in the nail group (weight bearing time 7.2 weeks) compared with the Spica casting group (weight bearing time 7.5 weeks). Conclusion: Elastic nail fixation yields better outcome for femoral shaft fracture in form of easier child handling, parent’s satisfaction, and maintaining acceptable fracture alignment.
Highlights
Femoral shaft fractures are among the most common pediatric injury, which have the highest incidence among other pediatric fractures, and treatment of them carries a lot of controversies
The first group was consisting of 30 children treated by Elastic Intramedullary Nail, while the second group was consisted of 30 children treated by hip Spica
Shortening of 2 cm was reported in the fractured side in 2 cases in nail group (6.7%), while in Spica group 6 cases were reported (20%) which was statically non-significant difference and this may be due to small sample size and this was comparable with Saseendar S. et al, while Jauquier N. et al shows significant discrepancy in Spica group that is may be due to 1 year follow up in their study
Summary
Femoral-shaft fractures are among the most common fractures of the lower extremity in children, with an annual incidence of up to 1 per 5000 in United States [1] [2], we couldn’t find any statistical data about the incidence in Iraq or Kurdistan region. Elastic nailing (EN) is commonly used to stabilize femoral fractures in the school-aged children [1]. This prospective randomized controlled study compares the outcome of the Elastic nail with Spica cast in treating femoral fractures in children in terms of recovery and complications and nursing difficulties. The type and location of the fracture, the degree of comminution, the age of the patient, the patient’s social and economic demands, all these factors determine the type of implant used for surgery. Risk factors suggested to be associated with complications of flexible nailing include [3]-[6]: 1) Age older than 10 or 11 years and weight exceeding 49 kg. Malunions are more frequent with flexible titanium nails than steel counterpart
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
