# Titanium Elastic Nail Fixation Versus Spica Cast Application for the Treatment of Diaphyseal Femoral Fractures in Children Under Five Years Old: A Retrospective Study

## TL;DR

This study compares titanium elastic nail fixation and spica cast treatment for femoral fractures in young children, finding that the nail method offers better healing and satisfaction but requires more procedures and pain management.

## Contribution

The study provides empirical evidence comparing titanium elastic nailing and spica casting for femoral fractures in children under five, highlighting clinical outcomes and caregiver satisfaction.

## Key findings

- TEN fixation showed superior short-term radiological outcomes with less angulation and shortening compared to spica casting.
- Caregiver satisfaction was higher with TEN fixation despite longer ambulation time and increased analgesic use.
- TEN fixation required more radiographs, longer follow-up, and additional procedures for nail removal.

## Abstract

Background

Femoral fractures are the most common type of injury requiring hospitalization in children. Treatment for femoral shaft fractures (FSFs) in children under six years old using closed reduction and spica cast (SC) application is a widely accepted method. In our institution, we offer the option of titanium elastic nail (TEN) fixation to parents of children under five years old. This study aimed to compare the results of SC treatment and TEN fixation in children under five years of age diagnosed with FSFs.

Methodology

We retrospectively reviewed medical records of all children under the age of five who had FSF treated at our institution and were managed with either an SC (28 children) or TEN fixation (26 children) between 2016 and 2022. The parents made the choice of treatment following discussions with the surgical team. In our analysis, the primary outcomes focused on radiological fracture healing and alignment, time until ambulation and limb mobilization, and complications. Additionally, we compared epidemiological data, hospitalization course, caregiver satisfaction, and follow-up duration between the two groups.

Results

No statistically significant differences were observed in time until fracture management or duration of anesthesia between the two groups. However, in the TEN group, short-term clinical and radiological outcomes were superior (coronal angulation: 0.92° vs. 5.9°, p = 0.0018; sagittal angulation: 0.42° vs. 7.82°, p = 0.0005; femoral shortening: 0.12 vs. 1.87 cm, p < 0.0001), although the time until ambulation was longer (5.9 vs. 4.75 weeks, p < 0.0001). Caregiver satisfaction was also higher in this group (p < 0.005). Conversely, children treated with TEN fixation more frequently required strong analgesic prescriptions (90% vs. 42%, p = 0.01), underwent more radiographs (during surgery: 6.73 vs. 3.61, p < 0.0001; during follow-up- 6.42 vs. 4.3, p = 0.003), had longer-lasting follow-up (7.9 vs. 3.2 weeks, p = 0.003), had an extended hospitalization (1.8 vs. 1.2 days, p = 0.004), and needed additional procedures for TEN removal. Both methods exhibited a low complication rate.

Conclusions

Titanium elastic nailing can be considered a viable treatment option for FSF in children aged two to five years, offering favorable clinical and radiological outcomes, enhanced caregiver satisfaction, and a low incidence of complications.