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

Abstract

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. Methods: Sixteen consecutive femur fractures in children 5-15 years of age were recruited prospectively over 13 months. An equal number of age-matched children treated by spica casting were recruited retrospectively. Subtrochanteric, supracondylar femur fractures were excluded. Results: Fracture union occurred earlier in the surgical group (6 weeks) than in the spica group (8 weeks) (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. Conclusion: 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. © 2010 EPOS.