Treatment of femoral fractures in children: Is titanium elastic nailing an improvement over hip spica casting?

S Saseendar,J Menon,D K Patro

doi:10.1007/s11832-010-0252-z

Abstract

The purpose of the study was to assess the validity of surgical interference with elastic nailing in treating pediatric femur fractures in comparison with the traditional treatment method-hip spica casting. Sixteen consecutive femur fractures in children 5-15years of age were recruited prospectively over 13months. An equal number of age-matched children treated by spica casting were recruited retrospectively. Subtrochanteric, supracondylar femur fractures were excluded. Fracture union occurred earlier in the surgical group (6weeks) than in the spica group (8weeks) (P=0.001). Spica casting caused higher coronal plane angulation (P=0.001), higher rotational malalignment (P<0.001), higher limb length discrepancy at 1-year follow-up (P<0.001), longer duration of immobilization (P<0.001), later full weight-bearing (P<0.001), and greater absence from school (P<0.001). Flynn outcome scores were better with titanium elastic nailing than with hip spica casting. Titanium elastic nailing led to better outcomes compared to hip spica casting in terms of earlier union, lower rates of malunion, shorter rehabilitation milestones, and better functional outcome scores.

Highlights

Femoral shaft fractures are among the most common major pediatric injuries treated by orthopedic surgeons [1] and result in high direct and indirect medical costs [2]
Purpose The purpose of the study was to assess the validity of surgical interference with elastic nailing in treating pediatric femur fractures in comparison with the traditional treatment method—hip spica casting
Flynn outcome scores were better with titanium elastic nailing than with hip spica casting

Summary

Introduction

Femoral shaft fractures are among the most common major pediatric injuries treated by orthopedic surgeons [1] and result in high direct and indirect medical costs [2] The treatment of such fractures has ranged from closed reduction with hip spica casting with or without traction to surgical stabilization with intramedullary devices, plates and screws, and external fixators [3,4,5,6]. While spica casting is effective for most children less than 6 years of age and the skeletally mature teenager is best managed with an antegrade interlocked intramedullary nail, the best treatment for children between 6 and 16 years of age is a matter of much debate [3,4,5,6] This age group had been managed by spica casting after a period of traction. Thereafter, these elastic stable intramedullary nails (ESINs) have been refined in many ways

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