Elastic intramedullary nail fixation versus external fixation for femoral fractures in children: comparison of clinical outcomes

Abstract

Objective To compare the therapeutic effect of elastic intramedullary nail fixation versus external fixator (Orthofix) for closed transverse or short oblique middle femoral shaft fractures in children. Methods Between March, 2009 and August, 2018, 67 children with closed transverse or short oblique middle femoral shaft fractures were treated with elastic intramedullary nail fixation (ESIN group, 34 cases) or external fixation (EF group, 33 cases). The operation time, intraoperative bleeding volume, fracture healing time, postoperative knee joint functions and postoperative complications were compared between the two groups. Results The EF group and ESIN group showed no significant difference in the operation time (110.67±54.04 vs 87.73±23.42 min, P 0.05). The rate of good postoperative knee joint function was significantly higher in ESIN group than in EF group (78.79% vs 97.06%, P < 0.05). The incidences of wound infections and refracture of the femoral shaft were significantly lower in ESIN group than in EF group (χ2=10.52, P < 0.05; χ2=5.57, P < 0.05, respectively), but the incidence of delayed union did not differ significantly between the two groups. Conclusion Compared with external fixation, elastic intramedullary nail fixation achieves better clinical outcomes with reduced postoperative complications, and is therefore recommended as the primary treatment option for closed transverse or short oblique middle femoral shaft fractures in children.

Keywords

• pediatric femoral shaft fractures
• fixation
• elastic intramedullary nail fixation
• external fixation