TITLE:
Comparative Study between the Elastic Nail versus Hip Spica Cast in Early Treatment of Pediatric Femoral Shaft Fractures
AUTHORS:
Rebar M. Noori Khaffaf, Abbas Hasan Altaweel
KEYWORDS:
Femoral Shaft Fractures, Elastic Nails, Hip Spica
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.6 No.9,
September
1,
2016
ABSTRACT: Introduction: Femoral shaft fractures are among the
most common pediatric injury, which have the
highest incidence among other pediatric fractures, and treatment of them
carries a lot of controversies. Aim of the study: To compare the outcome of fixation of femoral shaft fracture by elastic nail with
Spica cast. Patient and method: This prospective comparative study was carried
out in Sulaimani Teaching Hospital, in the period from the 10th of
December 2011 to the 10th of June 2012, for two groups of children
whose ages were between 4 - 12 years (average 6.61 years), sustained traumatic
femoral shaft fractures with follow-up period of about 6 months. The first
group was consisting of 30 children treated by Elastic Intramedullary Nail,
while the second group was consisted of 30
children treated by hip Spica. The selection was made on random bases. Results: Age range was between 4 - 12 years and
showed male predominance in
both groups with ratio of about 2:1 while fracture site showed predominance of the midshaft pattern in both
groups. This study showed highly significant
deference (P value of 0.001) between the two groups (Spica group of 3
days versus Nail group median of rate 4.5 days) in the admission period. Our
sample showed shortening of about 2 cm in 2
case in the Nail group (6.7%) versus 6 cases (20%) in Spica group. We
reported 4 cases of wound infection (13.3%) and 4 cases of pin site irritation (13.3%) in nail group. A higher
rate of malunion was observed in the Spica group (10 cases more than 10° angulation in coronal plane) while the Nail group reported 2 case more than 10°
in coronal plane. The mean operative time for Nail group was 55 minutes while
in Spica group was 30 minutes. We reported shorter time to start mobilization and walking with support or independently
in the nail group (weight bearing time 7.2
weeks) compared with the Spica casting group (weight bearing time 7.5 weeks). Conclusion: Elastic nail fixation yields better outcome for femoral shaft fracture in form of easier
child handling, parent’s satisfaction, and maintaining acceptable fracture alignment.