Clinical Report: Comparison of Elastic Nailing and Plate-Screw Fixation for Pediatric Femoral Shaft Fractures

Overview

Rephrase to clarify that both methods showed similar outcomes in fracture union and hospital stay, with P-values indicating no significant difference.

Background

Femoral shaft fractures are the most prevalent pediatric femoral injuries, necessitating effective treatment strategies. The choice between ESIN and plating remains contentious, with implications for recovery and complication rates. Understanding the comparative effectiveness of these surgical options is crucial for optimizing pediatric fracture management.

Data Highlights

Key Findings

• ESIN significantly reduced operative time compared to plating (MD -36.76 min, P = 0.03).
• Blood loss was significantly lower in the ESIN group (MD -94.77 mL, P < 0.00001).
• No significant difference in fracture union time between ESIN and plating (MD -1.30 weeks, P = 0.16).
• Hospital stay duration was similar for both techniques (MD -3.80 days, P = 0.18).
• ESIN was associated with implant-related irritation, while plating had higher rates of deep infection and postoperative stiffness.

Clinical Implications

Surgeons should consider ESIN for its advantages in reducing operative time and blood loss, particularly in younger, lighter patients. However, the potential for different complications necessitates careful patient selection and monitoring postoperatively.

Conclusion

ESIN presents a favorable option for pediatric femoral shaft fractures with shorter operative times and less blood loss, but careful consideration of complications is essential. Further multicenter RCTs are warranted to refine treatment guidelines.

References

1. Author(s)/Org, Source, Year -- Title
2. Results of Pediatric Proximal Femoral Fracture Management with 3.5 mm T-Plate Internal Fixation
3. Safety and Efficacy of Open Plate Fixation for Displaced Proximal Humerus Fractures in Children: Achieving Excellent Functional Results
4. Comparative Analysis of Biomechanical Stability Between Short and Long Proximal Femoral Nails in Osteoporotic A3 Reverse-Oblique Subtrochanteric Femoral Fractures: A Cadaver Study
5. Comparative Analysis of Extramedullary and Intramedullary Fixation Techniques for Stable Trochanteric Femoral Fractures: A Systematic Review and Meta-Analysis
6. Pediatric Orthopaedic Society of North America (POSNA)
7. https://new.aaos.org/globalassets/quality-and-practice-resources/pdff/pdffcpg.pdf
8. Elastic Stable Intramedullary Nailing Versus Plate Internal Fixation for Pediatric Diaphyseal Femur Fractures: A Systematic Review and Meta-analysis - PMC