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Comparative Assessment of Elastic Intramedullary Nailing Versus Conventional Plate Fixation for Pediatric Femoral
Li Zhang1, Chaokui Sun1, Yirong Guo2
1Surgery Clinic, Qinghai Provincial Women and Children's Hospital, 810007 Xining, Qinghai, China.
Insights
Elastic intramedullary nailing offers better early recovery for pediatric femoral shaft fractures compared to plate fixation. This technique provides minimal trauma and earlier weight-bearing, making it a suitable emergency treatment option.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Surgical Innovation
Background:
- Pediatric femoral shaft fractures require effective emergency surgical management.
- Traditional open reduction and plate fixation have been the standard treatment.
- Minimally invasive techniques are being explored for improved outcomes.
Purpose of the Study:
- To compare clinical outcomes of elastic intramedullary nailing (EIN) versus open reduction and plate fixation (ORPF) for pediatric femoral shaft fractures.
- To evaluate perioperative data, functional recovery, and complication rates.
- To determine the optimal emergency surgical approach for these fractures.
Main Methods:
- Retrospective study of 313 pediatric patients with femoral shaft fractures treated emergently.
- Propensity score matching (PSM) created two groups: EIN (n=120) and ORPF (n=120).
- Comparison of operative time, blood loss, fluoroscopy, functional scores (knee and hip), and complications.
Main Results:
- EIN group showed shorter operative times, smaller incisions, less blood loss, and reduced fluoroscopy.
- The EIN group achieved earlier full weight-bearing and superior knee/hip function scores at 3 and 6 months post-surgery.
- All fractures achieved union; EIN had no serious complications, while ORPF had two minor incision infections.
Conclusions:
- Both EIN and ORPF provide favorable outcomes for pediatric femoral shaft fractures in emergency settings.
- EIN demonstrates advantages including minimal surgical trauma, earlier weight-bearing, and faster recovery.
- EIN is a suitable and effective option for emergency surgical management of these fractures.
Aim:
This study aims to compare the clinical outcomes between elastic intramedullary nailing and traditional open reduction and plate fixation for pediatric femoral shaft fractures in the emergency setting.
Methods:
This retrospective study enrolled 313 pediatric patients with femoral shaft fractures who underwent emergency surgical treatment at Qinghai Provincial Women and Children's Hospital between January 2023 and February 2024. After propensity score matching (PSM), patients who received elastic stable intramedullary nailing were assigned to the observation group (n = 120), whereas those who were treated with traditional open reduction and plate fixation were included in the control group (n = 120). Perioperative data, postoperative knee function, range of motion, and incidence of complications were compared between the two groups.
Results:
Patients in the observation group demonstrated shorter operative times and smaller incision lengths than those in the control group. They also experienced reduced intraoperative blood loss and minimal fluoroscopic exposures, and achieved full weight-bearing earlier than those in the control group (p < 0.001). At both 3 and 6 months after surgery, knee function scores, knee range-of-motion scores, and total Hospital for Special Surgery (HSS) scores were higher in the observation group, along with improved knee stability score (p < 0.05). At 3 months postoperatively, the hip function score, hip range-of-motion score, and total Harris Hip score were also higher in the observation group (p < 0.01). Successful fracture union was achieved in all children, with no serious postoperative complications observed in either group. In the control group, two cases developed incision-site infections, which were cured after debridement and anti-infective treatment.
Conclusions:
In the emergency setting, both elastic intramedullary nailing and conventional open reduction with plate fixation can achieve favorable clinical outcomes in children with femoral shaft fractures. Elastic intramedullary nailing offers distinct advantages, such as minimal surgical trauma, earlier postoperative weight-bearing, and better early recovery, rendering it a suitable option in this clinical setting.
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