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Titanium Elastic Nails Versus Spica Cast in Pediatric Femoral Shaft Fractures: A Systematic Review and Meta-analysis

Mohamed A Imam^{1,2,3,4,5,6,7,8}, Ahmed S Negida^{1,2,3,4,5,6,7,8}, Ahmed Elgebaly^{1,2,3,4,5,6,7,8}

¹Department of Trauma and Orthopaedics, Faculty of Medicine, Suez Canal University, Egypt Ashford and St Peters NHS Trust, Chertsey, UK.

The Archives of Bone and Joint Surgery

|June 19, 2018

Insights

Titanium Elastic Nails (TEN) are more effective than Spica casts for treating pediatric femoral shaft fractures in children aged 2-16. TEN fixation leads to better alignment and faster independent walking, making it the recommended treatment.

Area of Science:

Orthopedic surgery
Pediatric traumatology
Biomechanical engineering

Background:

Management of pediatric femoral fractures lacks consensus for ages 2-16.
Titanium Elastic Nails (TEN) show promise but require further comparative analysis.
This study addresses the debate between TEN and Spica casts for this age group.

Purpose of the Study:

To systematically compare the efficacy of Titanium Elastic Nails (TEN) versus Spica cast for femoral shaft fractures in children aged 2-16.
To evaluate outcomes including fracture alignment, union time, and functional recovery.
To provide evidence-based recommendations for pediatric femoral fracture management.

Main Methods:

Systematic meta-analysis of randomized controlled trials and observational studies.
Searched PubMed, Scopus, Web of Science, CINAHL, and Cochrane Central databases.
Included 12 studies with 1012 patients, analyzed using Review Manager 5.3.

Main Results:

TEN fixation showed significantly better sagittal and coronal alignment compared to Spica casts (SMD -0.48 and -0.66, respectively).
Risk of malalignment was significantly lower with TEN (RR=0.39).
TEN also favored outcomes for walking independently, though union time and hospital stay varied.

Conclusions:

Titanium Elastic Nails (TEN) fixation is superior to Spica cast for pediatric femoral shaft fractures in patients younger than 16 years.
Recommend TEN fixation for improved outcomes in pediatric femoral fracture management.
Further research may explore optimizing TEN protocols for specific fracture types.

Read full analysis

Abstract

Background:

There is a general consensus on the management of femoral fractures in children younger than two years and adolescents older than sixteen years. The best treatment for patients younger than sixteen years of age is still debatable. Titanium Elastic Nails (TEN), is widely used with some evidence, nonetheless, we undertook a systematic meta-analysis to assess the efficacy of TEN compared to Spica cast for the management of femoral shaft fracture in children aged between 2 to 16 years old.

Methods:

A computer literature search of PubMed, Scopus, Web of Science, CINAHL and Cochrane Central was conducted using relevant keywords. We included clinical trials and observational studies that compared TEN versus Spica cast; Records were screened for eligible studies and data were extracted and synthesized using Review Manager version 5.3 for Windows. Our search found 573 unique articles. After screening the abstract and relevant full text, 12 studies with a total of 1012 patients were suitable for the final analysis.

Results:

In terms terms of union (in weeks), the reported effect sizes favoured the TEN group in two included studies only. Moreover, the overall standardized mean difference in sagittal (SMD -0.48, 95% CI [-0.70 to -0.26], P<0.001) and coronal angulations (SMD -0.66, 95% CI [-1.00 to -0.31], P<0.001) favored TEN fixation in management of femoral fractures younger than 16 years. The reported length of hospital stay was not consistent across studies. The overall risk ratio of malalignment (RR=0.39, 95% CI [0.27 to 0.57], P<0.001) favored the TEN as well as walking independently. Based on our analysis, TEN treatment is superior to traction and hip spica for femoral fractures in patients younger than 16 years old.

Conclusion:

Based on our analysis we recommend the use of TEN fixation in management of pediatric femoral fractures in patients younger than 16 years.

Keywords:

Femoral fractures Flexible nails Spica cast Titanium elastic nails

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