Abstract
BackgroundThere is no consensus on treatment of closed femoral-shaft fractures in children. We compared hip spica cast with titanium elastic nailing (TEN) in the treatment of femoral-shaft fractures in children.Materials and methodsForty-six children, 6–12 years old, with simple femoral-shaft fractures were randomized to receive skeletal traction followed by hip spica cast (n = 23) or TEN (n = 23). Length of hospital stay, time to start walking with aids, time to start independent walking, time absent from school, parent satisfaction, and range of knee motion were compared between the two groups 6 months after injury.ResultsThe two groups were similar in background characteristics. Compared with the children treated with spica cast, those treated with TEN had shorter hospital stay (P < 0.001) and took a shorter time to start walking with support or independently (P < 0.001), returned to school sooner (P < 0.001), and had higher parent satisfaction (P = 0.003). Range of knee motion was 138.7 ± 3.4° in the spica cast group and 133.5 ± 13.4° in the TEN group (P = 0.078). Three patients (13.0%) in the spica cast group compared with none in the TEN group had malunion (P = 0.117). Postoperative infection was observed in three patients (13.0%) in the TEN group.ConclusionsThe results showed significant benefits of TEN compared with traction and hip spica cast in the treatment of femoral-shaft fractures in children. Further trials with longer follow-ups and comparison of TEN with other methods, such as external fixation, in children’s femoral fractures are warranted.
Highlights
Femoral-shaft fractures are among the most common fractures of the lower extremity in children, with an annual incidence of up to 1 per 5,000 [1, 2]
Compared with the children treated with spica cast, those treated with titanium elastic nailing (TEN) had shorter hospital stay (P \ 0.001) and took a shorter time to start walking with support or independently (P \ 0.001), returned to school sooner (P \ 0.001), and had higher parent satisfaction (P = 0.003)
We showed the benefits of the TEN surgical method versus traction and spica casting with respect to hospital stay, time to start walking with support or independently, returning to school, and parent satisfaction
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 5,000 [1, 2]. Titanium elastic nailing (TEN) is commonly used to stabilize femoral fractures in school-aged children, but there have been few controlled studies and with only relatively short-term. According to the lack of data in this regard, we designed a prospective randomized controlled study to compare TEN with traction and a spica cast in treating femoral fractures in children in terms of recovery and complications. We compared hip spica cast with titanium elastic nailing (TEN) in the treatment of femoral-shaft fractures in children. Materials and methods Forty-six children, 6–12 years old, with simple femoral-shaft fractures were randomized to receive skeletal traction followed by hip spica cast (n = 23) or TEN (n = 23). Time to start walking with aids, time to start independent walking, time absent from school, parent satisfaction, and range of knee motion were compared between the two groups 6 months after injury
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