Comparison Between Elastic Stable Intramedullary Nailing and Conservative Management in Children with Diaphyseal Femoral Fracture

Yasir Umer; Syed Junaid Ismail; Amir Nisar; Waleed Umer; Nadia Junaid

doi:10.51253/pafmj.v75i5.11352

Authors

Yasir Umer Department of Orthopedic Surgery, Federal Government Polyclinic Hospital, Islamabad, Pakistan
Syed Junaid Ismail Department of Orthopedic Surgery, Federal Government Polyclinic Hospital, Islamabad, Pakistan
Amir Nisar Department of Orthopedic Surgery, Ali Medical Centre Islamabad, Pakistan
Waleed Umer Department of General Surgery, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Nadia Junaid Department of Community Medicine, Federal Medical College, Islamabad Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75i5.11352

Keywords:

Elastic Stable Intramedullary Nailing, Femur, Fracture, Hip Spica Cast

Abstract

Objective: To compare the outcome between elastic stable intramedullary nailing (ESIN) and conservative management with hip spica cast in children with diaphyseal femoral fractures.

Study Design: Quasi-experimental study.

Place and Duration of Study: Orthopedic Surgery Department, Federal Government Polyclinic Hospital, Islamabad, Pakistan, from Jan 20 -21.

Methodology: Seventy-two (n=72) children with diaphyseal femoral fractures were included and divided into two Groups. Group-A patients were treated with ESIL, whereas Group B patients were treated with Hip Spica Cast. Post-procedure, patients were followed up, and outcomes were determined. Data was analyzed using a Statistical Package for Social Sciences 22.

Results: The mean age of seventy-two (n=72) children was 6.86±2.45 years. 40(55.56%) were males and 32(44.44%) were females. The mean length of postoperative hospital stay in Group A was 1.72±0.66 days, while in Group B it was 1.44±0.65 days (p=0.077). The mean time taken for assisted weight bearing in Group A was 57.88±11.75 days, while in Group B it was 67.13±8.65 days (p<0.001). The mean time taken to return to school in Group A was 71.05±12.72 days, while in Group B it was 78.55±13.20 days (p=0.017).

Conclusion: ESIN for femoral diaphyseal fracture was associated with early return to assisted weight bearing and early return to school.

Downloads

Download data is not yet available.

References

1. Kakakhel MMG, Rauf N, Khattak SA, Adhikari P, Askar Z. Femoral Shaft Fractures in Children: Exploring Treatment Outcomes and Implications. Cureus 2023; 15(10): e46336.

https://doi:10.7759/cureus.46336

2. Mansoor K, Shahnawaz S, Ahmad A, Arif MM, Hamza M. Epidemiology of childhood fractures in the city of karachi. J Ayub Med Coll Abbottabad 2015; 27(3): 608-612.

3. Kamienski MC. Pediatric Femur Fractures. Orthop Nurs 2020; 39(2): 107-111.

https://doi:10.1097/NOR.0000000000000641

4. Brnjoš K, Lyons DK, Hyman MJ, Patel NM. National trends in the treatment of femur fractures in the preschool population: Age and geography play a role. Injury. 2021; 52(7): 1766-1770.

https://doi:10.1016/j.injury.2021.04.022

5. Frei B, Mayr J, de Bernardis G, Camathias C, Holland-Cunz S, Rutz E. Elastic stabile intramedullary nailing (ESIN) of diaphyseal femur fractures in children and adolescents: A strobe-compliant study. Medicine 2019; 98(14): e15085.

https://doi:10.1097/MD.0000000000015085

6. Medda S, Unger T, Halvorson J. Diaphyseal Femur Fracture. 2023 Feb 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.

7. Hwaizi LJ, Saeed AMS, Mahmood MN. Diaphyseal femoral fractures in children: comparison between elastic stable intramedullary nailing and conservative management. Open Orthopaed J 2018; 12: 435-444.

https://doi:10.2174/1874325001812010435

8. Kalbitz M, Fischer A, Weber B, Mayer B, Lackner I, Pressmar J. Diaphyseal femur fractures in children and adolescents-opportunities and limitations of the ESIN technique. J Clin Med 2022; 11(24): 7345. https://doi:10.3390/jcm11247345

9. Khoriati AA, Jones C, Gelfer Y, Trompeter A. The management of paediatric diaphyseal femoral fractures: a modern approach. Strategies Trauma Limb Reconstr 2016; 11(2): 87-97.

https://doi:10.1007/s11751-016-0258-2

10. Liau GZQ, Lin HY, Wang Y, Nistala KRY, Cheong CK, Hui JHP. Pediatric femoral shaft fracture: an age-based treatment algorithm. Indian J Orthop 2020; 55(1): 55-67.

https://doi:10.1007/s43465-020-00281-6

11. Chen X, Lu M, Xu W, Wang X, Xue M, Dai J, et al. Treatment of pediatric femoral shaft fractures with elastic stable intramedullary nails versus external fixation: A meta-analysis. Orthop Traumatol Surg Res 2020; 106(7): 1305-1311.

https://doi:10.1016/j.otsr.2020.06.012

12. Schmittenbecher PP. Dia- und metaphysäre Femurfrakturen im Kindesalter [Diaphyseal and metaphyseal femoral fractures in childhood]. Chirurg 2021; 92(5): 485-496.

https://doi:10.1007/s00104-020-01342-0

13. Arneitz C, Szilagyi I, Lehner B, Kienesberger B, Gasparella P, Castellani C, et al. Therapy preference of 131 parents confronted with a pediatric femoral fracture. Front Pediatr 2022; 10: 949019.

https://doi:10.3389/fped.2022.949019

14. DiFazio R, Vessey J, Zurakowski D, Hresko MT, Matheney T. Incidence of skin complications and associated charges in children treated with hip spica casts for femur fractures. J Pediatr Orthop 2011; 31(1): 17-22.

https://doi:10.1097/BPO.0b013e3182032075

15. Nielsen E, Bonsu N, Andras LM, Goldstein RY. The effect of canal fill on paediatric femur fractures treated with titanium elastic nails. J Child Orthop 2018; 12(1): 15-19.

https;//doi:10.1302/1863-2548.12.170083

16. Denisiuk M, Afsari A. Femoral Shaft Fractures. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK556057/

17. Bhuyan BK, Mohan Singh S. Titanium elastic nailing in pediatric femoral diaphyseal fractures in the age Group of 5-16 years - A short term study. J Clin Orthop Trauma 2014; 5(4): 203-210.

https://doi:10.1016/j.jcot.2014.08.001

18. Shemshaki HR, Mousavi H, Salehi G, Eshaghi MA. Titanium elastic nailing versus hip spica cast in treatment of femoral-shaft fractures in children. J Orthop Traumatol 2011; 12(1): 45-48.

https://doi:10.1007/s10195-011-0128-0

19. Soleimanpour J, Ganjpour J, Rouhani S, Goldust M. Comparison of titanium elastic nails with traction and spica cast in treatment of children's femoral shaft fractures. Pak J Biol Sci 2013; 16(8): 391-395.

https://doi:10.3923/pjbs.2013.391.395

20. Ikram M, Rao SE, Gul N, Memon ML, Muzammil S. Comparison of Titanium Elastic Nailing and Spica Casting Outcomes in Preschool Children Following Femoral Diaphyseal Fractures. J Univ Med Dent Coll 2023; 14(3): 655-660.

https://doi.org/10.37723/jumdc.v14i3.818