Comparison of Treatment with Titanium Elastic Nail Versus AO – Dynamic Compression Plate for Femoral Shaft Fractures in Children

Abstract

<p><strong>Abstract</strong></p><p><strong>Background: </strong>Femur fractures are among the commonest pediatric injuries. Until recent past, traction and hip spica were the standard treatment for all femoral shaft fractures which required long duration of hospitalization. The management of femoral shaft fractures in children above the age of six years has evolved more towards operative approaches in the last two decades to minimize the post plaster complications i.e. decrease in incidence of malunion, short hospital stay, better nursing care and early ambulation. Recently, a variety of therapeutic alternatives such as intramedullary nailing and dynamic compression plating have become available to decrease impairment, increase convenience and decrease cost of care.</p><p><strong>Objective: </strong>To compare the results of fracture shaft of femur in children (6 to 12 years of age) treated with Titanium Elastic Nail vs. AO – Dynamic Compression Plate fixation.</p><p><strong>Methods: </strong>This prospective, comparative and interventional study was carried out in the department of orthopedic surgery, PGMI Lahore General Hospital, Lahore. A total of 64 patients were enrolled in this study and randomly divided into 2 groups of 32 patients each. In Group-A patients were treated with Titanium Elastic Nail and in Group – B patients were treated with AO – Dynamic Compression Plate fixation. Sample selection was done by using a pre-defined inclusion and exclusion criteria. Variables of interest were duration of operation, Infection, Limb Length discrepancy, Angulation, Time of union and implant failure. Patients were followed up from 2nd week till 24th week respectively. SPSS was used for data entry and analysis.</p><p><strong>Results: </strong>Age range of patients was 6 – 12 years. Male patients were 51 and 13 patients were female. Eleven patients had Proximal 1/3, 45 mid shaft fracture and 8 distal 1/3 fracture. Mean operative time for DCP was 53.28 minutes and for elastic intramedullary nailing was 29.91 minutes. None of the patients in both treatment groups had limb length discrepancy. Infection and implant failure rate were the same in both treatment groups. Union was rapid till 8th week in Group-A patients after 8th week both treatment groups had equal union rate.</p><p><strong>Conclusion: </strong>Union was achieved in all cases in both groups. Angulation, Infection and implant failure was not seen in any of the patients in both treatment gro-ups. An earlier union of bone was earlier in Group-A (Elastic Intramedullay Nail) patients as compared to Group-B (DCP).</p><strong>Key Words: </strong>AO – DCP, Titanium Elastic Nail, Pediatric Mid Shaft Femur, Infection, Union.

Plate fixation versus flexible intramedullary nails for management of closed femoral shaft fractures in the pediatric population: A systematic review and meta-analysis of the adverse outcomes

“…Thirteen studies (11 retrospective cohorts; 2 prospective randomized controlled trials) reporting 805 closed femoral fractures in 801 children were eligible for inclusion (Table 1). 1,[16][17][18][19][20][21][22][23][24][25][26][27] Studies were from the United Kingdom, United States, Israel, India, China, and Pakistan. There were 559 males (69.8%) and 242 females (30.2%) with the reported mean ages in the included studies ranging from 5.9 to 10.6 years.…”

“…With respect to the secondary outcomes, infection (of the bone or the soft tissues) was reported in all studies (Table 3). 1,[16][17][18][19][20][21][22][23][24][25][26][27] Twelve studies 1,16,[18][19][20][21][22][23][24][25][26][27] reported leg-length difference and 11 studies [16][17][18][19][20][21][22][23][24][25][26][27] reported unplanned reoperations (Table 4). These secondary outcomes were pooled and are expressed as summary statistics.…”

“…Study definitions of outcome measure and risk of bias assessment (non-randomized studies). Ahmed et al24 NU not defined, term used as diagnosis, MU not defined, term used as diagnosis. SI term used but not defined, OM term not used, UR term not used, LLD term used but not defined.…”