Femoral shaft fractures in children: traction and spica casting (conservative treatment) versus closed titanium elastic nailing: A clinical study at Eastern India

Background: Femoral fractures are among the most common fractures of long bones. The management of paediatric femoral fractures depends primarily on the age of the child although the bone age and size of a child may determine the choice of treatment. Multiple traumas may necessitate rapid stabilization of femoral shaft fractures to facilitate overall care. Not many years ago, traction and casting were standard treatment for all femoral shaft fractures in children, and femoral fractures ranked high in duration of hospitalization for a single diagnosis. The aim of my study was to compare the results of conservative treatment and closed intra-medullary titanium elastic nailing in cases of fractures shaft femur in children. Materials & Methods: The patients with fractures shaft of femur attending either emergency or outdoor and also patients referred from peripheral hospitals were selected. We included the patient of 5 year to 10 year with closed fractures shaft of femur in children including Gustillo type I fractures. We excluded patients with an active infection, Gustillo type II and type III open fractures of shaft femur, pathological fractures, and abnormal medullary cavity. Out of the 42 patients, 23 were treated by intra-medullary titanium elastic nailing and 19 were treated by surface traction for three weeks followed by one and a half hip spica. After titanium elastic nailing, physical therapy with touchdown weight-bearing was begun as soon as the patient was comfortable, generally around 3weeks. Gentle knee exercises and quadriceps strengthening were begun. Full weight-bearing generally was given by 8 weeks. In conservatively managed group the cast was used until six to eight weeks after the injury. After the cast has been removed, management included skin care and physical therapy with touchdown weight-bearing was begun. Ambulation was accomplished with weight bearing as tolerated. The patients were evaluated at the regular interval of 2, 4, 6 & 8 weekly and after that every month. Results: In the patients treated with titanium elastic nailing the results were excellent in 16 (69.5%) patient, successful in 6 (26%) patient, and poor in 1(4.5%) patient. In the patient treated with traction and spica cast the results were excellent in 11 (58%) patients, successful in 6 (31.5%) and poor in 2 (10.5%) patients. Compared with the children treated with traction and a cast, those treated with titanium elastic nails had significantly shorter hospitalization period(p<0.0001), mean 8.5 days in operated group compared to mean 26 days in conservatively treated group. The time taken for full weight bearing was also significantly less in patient treated with titanium elastic nailing (p<0.0001); mean 9.1 weeks in operated group compared to 11.5 weeks in conservatively treated group. Conclusion: We conclude that closed pediatric femoral shaft fractures within the ages of 5-10 years can be treated successfully by any methods of traction followed by spica cast or intramedullary titanium elastic nailing. However, because of shorter immobilization period and earlier ambulation, we recommend internal fixation with titanium elastic nailing as the better choice to treat this fracture in school aged children