Titanium elastic nailing versus hip spica cast in treatment of femoral-shaft fractures in children

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.

Comparative Study between the Elastic Nail versus Hip Spica Cast in Early Treatment of Pediatric Femoral Shaft Fractures

“…Our study showed male predominance in both groups and this was comparable to the studies published by Shemshaki H. R. et al [2], Saseendar S. et al [3] and Jauquier N. et al [6]. Regarding fracture site, our study showed middle third predominance in both groups and this is comparable with the studies published by Shemshaki et al [2], Jauquier N. et al [3] and Nicolas Lutz et al [4].…”

“…Regarding fracture site, our study showed middle third predominance in both groups and this is comparable with the studies published by Shemshaki et al [2], Jauquier N. et al [3] and Nicolas Lutz et al [4]. Our study sample showed highly significant.…”

“…Spica cast immobilization is a simple, effective and safe treatment for a femoral shaft fracture in children [8] [9]. It remains universally used, but is especially suited for children under the age of 5 years [6], when there is still significant potential for remodeling and the relatively light weight of child allows easy carrying and transfer [2]. The AAOS (American Academy of Orthopedic Surgeons) Clinical practice Guideline for the treatment of pediatric diaphyseal femur fracture suggests early Spica casting or traction with delayed Spica casting in children aged 6 months to 5 years [6].…”

“…Radiological union was achieved in a mean time of 5.4 weeks. Postoperative follow up first was weekly for 2 weeks then every two weeks till fracture consolidation (8 -12 weeks) and then monthly intervals till patient can walk with full weight bearing and every visits patients were clinically and radio logically evaluated and at 6 months the final results were evaluated using criteria of Flynn et al [2] [8] (Tables 1-3 …”

Management of pediatric diaphyseal femur fractures

“…For older children, an important study in 2010 by Shemshaki et al compared the use of titanium elastic nailing (TEN) to hip spica casting in 46 patients, aged 6 to 12 years, with simple femur fractures [24]. Compared to patients treated with a spica cast, those treated with TEN had shorter hospital stays, took a shorter time to start walking, returned to school sooner, had a lower rate of malunion, and had higher parent satisfaction.…”