Evaluation of outcome of titanium elastic nailing (TEN) versus hip spica cast in the treatment of femoral shaft fractures in children

Abstract

Femoral shaft fractures are among the most common pediatric injury and treatment of them carries a lot of controversies. The aim of this study was to compare the outcome of titanium elastic nailing versus hip spica cast in femoral shaft fractures in children. This prospective study was conducted on 40 children of 5 to 15 years of age treated with titanium elastic nail or early hip spica cast for the fracture shaft of femur during July 2016 to October 2017 in the Department of Orthopaedics, R.I.M.S., Ranchi, Jharkhand. Majority of patients in both treatment group were male child with overall boy to girl ratio was 1.85:1. Mean age in titanium elastic nailing group was 9.82 ± 2.99 years and in spica group was 8.35 ± 2.53 years. RTA was most common mechanism of injury and right limb was more commonly involved in both groups. Union time was less in titanium elastic nailing group (8.80 1.76 week) than spica group (10.20 2.33 week) (p = 0.039). Patients in titanium elastic nailing group walked with and without support earlier than the spica cast group (p = 0.000). Most common complication in titanium elastic nailing group was limb lengthening (50%) followed by mal alignment (40%) while in spica group it was limb shortening (65%) followed by mal alignment (55%). Overall complication was higher in spica group. At final analysis, Flynn score was better in titanium elastic nailing group than in hip spica group (p = 0.365). Titanium elastic nailing is better method for the management of femoral shaft fractures in children as it results in higher rate of excellent functional outcome with lower incidence of complications.