A Prospective Study of Comparison between Stable and Unstable Pediatric Femoral Shaft Fractures Treated With Titanium Elastic Nails

Introduction: Femoral shaft fractures represent approximately 1.6% of all bone injuries in children. Angulation, malrotation, and shortening are not always corrected effectively by conservative methods. These also depend on fracture anatomy: Stable (transverse and oblique) and unstable (spiral and comminuted). In recent years, flexible intramedullary nailing has gained wide acceptance for treating pediatric and adolescent femoral fractures because of the lower chance of iatrogenic infection and the prohibitive cost of in-hospital traction and Spica cast care. The present prospective study was designed to evaluate outcomes of stable and unstable diaphyseal femoral fractures in children aged 5-15 years using the titanium elastic nailing (TEN) system. Both subjective and objective parameters were assessed, including pain relief, patient comfort, early mobilization, surgical technique, radiographic union, progression of weight bearing, and post-operative complications. Materials and Methods: Children and adolescents between 5 and 15 years of age with femoral shaft fractures admitted to Teerthanker Mahaveer Medical College and Research Centre, Moradabad, and fulfilling the inclusion criteria were enrolled in the study. All selected patients were treated using TEN for fracture fixation. Post-operative follow-up was conducted over 6 months at 6, 12, and 24 weeks. A total of 90 cases were analyzed, comprising 45 stable and 45 unstable fractures. The results showed favorable outcomes in stable fracture cases, whereas among unstable fractures, three patients developed angular deformities and one patient had limb shortening. Conclusion: Titanium elastic nails lead to rapid fracture union by preservation of fracture hematoma and limited soft tissue exposure. It also helps in preventing damage to the physis. A stable pediatric femoral diaphyseal fracture has very good results with minimal complications. Unstable pediatric femoral diaphyseal fractures, though they had good results in most cases, had angular deformities in 3 cases, and 1 case developed limb shortening. Based on the findings of this study, alternative surgical methods may be more suitable for severely unstable pediatric femoral shaft fractures. Overall, TEN should be regarded as the preferred treatment option for femoral diaphyseal fractures in children aged 5-15 years.