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Comparative Outcomes of Elastic Stable Intramedullary Nailing vs. Plate Fixation in Pediatric Femoral Shaft
Omar Al-Doori1, Mohammad Abdalla2, Sail Zaid Alkhaion3
1Aneurin Bevan University Health Board Headquarters, St Cadoc's Hospital, Lodge Road, Caerleon, Newport, Wales.
Insights
Elastic Stable Intramedullary Nailing (ESIN) is preferred for pediatric femoral shaft fractures in children aged 5-10. This method offers shorter operative times and faster weight-bearing compared to plate fixation.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Trauma surgery
Background:
- Pediatric femoral fractures are common, necessitating effective treatment strategies.
- Treatment choice for pediatric diaphyseal femoral fractures varies by age.
- This study focuses on children aged 5-10 years.
Purpose of the Study:
- To compare the efficacy of Elastic Stable Intramedullary Nailing (ESIN) versus plate fixation.
- To evaluate outcomes for transverse diaphyseal femoral fractures in pediatric patients.
- To determine the optimal surgical approach for this demographic.
Main Methods:
- Prospective study of 32 children with closed transverse diaphyseal femoral fractures.
- Patients divided into two groups: 16 treated with ESIN and 16 with plate fixation.
- Exclusion criteria included comminuted, open, or pathological fractures.
Main Results:
- ESIN group (16 patients) showed shorter operative times (58.4 min) and faster union (8.8 weeks) than plate fixation (76.3 min, 11.9 weeks).
- Significantly less blood loss observed with ESIN (32.8 ml) compared to plate fixation (205.0 ml).
- No significant differences in wound healing or leg length discrepancy between groups.
Conclusions:
- Elastic Stable Intramedullary Nailing (ESIN) is preferable to plate fixation for pediatric femoral shaft fractures in children aged 5-10.
- ESIN offers advantages in operative time and weight-bearing commencement.
- Plate fixation may be suitable in specific clinical situations; further studies are recommended.
Background:
Pediatric femoral fractures are common in emergency rooms, with treatment options varying by age. This study compares elastic stable intramedullary nailing (ESIN) and plate fixation for diaphyseal femoral fractures in children aged 5-10.
Material And Methods:
Conducted at Al-Kindi Teaching Hospital, Baghdad, from December 2017 to December 2019, this prospective study included 32 children with closed transverse diaphyseal femoral fractures. Patients were divided into two groups: 16 treated with ESIN (Group 1) and 16 with plate fixation (Group 2). Criteria excluded comminuted, open, or pathological fractures.
Results:
Group 1 had a mean age of 7.1 years and weight of 23.7 kg; Group 2 had a mean age of 7.8 years and weight of 30.9 kg. ESIN resulted in shorter operative times (58.4 minutes), earlier weight-bearing, and quicker fracture union (8.8 weeks) compared to plate fixation (76.3 minutes, 11.9 weeks). Blood loss was significantly less in Group 1 (32.8 ml) versus Group 2 (205.0 ml). No significant differences in wound healing or leg length discrepancies were observed.
Conclusions:
1. Our study indicates a preference for Elastic Stable Intramedullary Nailing (ESIN) over plate fixation for pediatric femoral shaft fractures in children aged 5-10 years. 2. ESIN is associated with shorter operative times and faster commencement of weight-bearing, critical in pediatric recovery. 3. While ESIN is generally preferable, plate fixation may be better suited in certain clinical scenarios, emphasizing the importance of personalized treatment. 4. Based on our findings, ESIN is recommended for treating transverse diaphyseal femur fractures in the specified pediatric age group. 5. Recommends further studies, including randomized controlled trials, for a more comprehensive understanding of these treatments' long-term outcomes.
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