Combined Elastic Stable Intramedullary Nail and External Fixation Versus Elastic Stable Intramedullary Nail Alone in the Management of Length-Unstable Pediatric Femoral Fractures: A Prospective Randomised Controlled Clinical Study

Abstract

Background: Femoral shaft fractures account for approximately 1.6% of fractures in the pediatric population. However, the optimal treatment modality for length-unstable fractures is still controversial. Objectives: Our study aims to compare combined elastic stable intramedullary nail (ESIN) and external fixation (EF) versus ESIN alone in the management of length-unstable femur fractures in pediatric patients in terms of surgical, functional, and radiological outcomes. Patients and Methods: Forty patients (20 in each group) with length-unstable femur fractures. First group was managed by ESIN and EF, and the other group was managed by ESIN alone. Both groups were compared in terms of surgical, functional, and radiological outcomes. Results: The mean follow-up period was 8.4 ± 1.2 months in the ESIN group and 9.1 ± 1.6 months in the ESIN/EF group. Radiological outcomes, as measured by Beaty’s criteria, have shown a statistically significant difference between groups. However, both groups has similar functional outcomes and rate of postoperative complications. Conclusion: This study has demonstrated superiority of ESIN/EF over ESIN alone in terms of radiological outcomes with no significant differences as regards functional outcomes and postoperative complications.