Functional outcomes of titanium elastic nail procedure after femoral shaft fracture in pediatric patients

Abstract

Pediatric femur diaphyseal fractures are seen after serious traumas such as traffic accidents and fall from height. Although treatment algorithms are made according to age groups, treatment planning is individualized according to the patient and the degree of injury. In our study, we evaluated functional outcomes of pediatric femur fractures treated with titanium elastic nail (TEN). This is a retrospective study including pediatric femoral diaphyseal fractures treated with TEN between 2012 and 2021. Open fractures, pathological fractures, distal fractures involving the femoral condyles, and proximal fractures involving the trochanteric region were not included in our study. Thirty-three femoral diaphyseal fractures with complete data were identified as stable and unstable in length, and functional results and post-treatment complications were recorded by performing TEN in fracture fixation. Clinical functional results were analyzed with Flynn criteria. Thirty-three femoral fractures of 29 patients were included. Eighteen (62.1%) of our patients were boys and 11 (37.9%) were girls. The mean age was 6.51 years (4-13 years). The most common injury mechanism was traffic accidents seen in 19 patients (24.51%). The mean follow-up period after surgery was 26.6 (6-90 months) months. Stable fractures (transverse and short oblique) were found in 26 cases (78.7%) and unstable fractures (spiral/long oblique and comminuted) in 7 cases (21.7%). According to Flynn criteria, excellent results were found in 20 fractures (60.6%) and satisfactory results in 10 fractures (30.3%) and 3 poor (%9.09). There was no significant difference between stable and unstable fractures in terms of functional outcome (p=0.12). Femoral diaphyseal fractures are serious injuries that require surgery. Regardless of the type of fracture, stable or unstable in length, the results of treatment with TEN are very successful. Major complications such as nonunion and re-fracture are rarely seen with this treatment.