Treatment of femoral fractures in children: Is titanium elastic nailing an improvement over hip spica casting?

Purpose The purpose of the study was to assess the validity of surgical interference with elastic nailing in treating pediatric femur fractures in comparison with the traditional treatment method—hip spica casting. Methods Sixteen consecutive femur fractures in children 5–15 years of age were recruited prospectively over 13 months. An equal number of age-matched children treated by spica casting were recruited retrospectively. Subtrochanteric, supracondylar femur fractures were excluded. Results Fracture union occurred earlier in the surgical group (6 weeks) than in the spica group (8 weeks) ( P = 0.001). Spica casting caused higher coronal plane angulation ( P = 0.001), higher rotational malalignment ( P < 0.001), higher limb length discrepancy at 1-year follow-up ( P < 0.001), longer duration of immobilization ( P < 0.001), later full weight-bearing ( P < 0.001), and greater absence from school ( P < 0.001). Flynn outcome scores were better with titanium elastic nailing than with hip spica casting. Conclusion Titanium elastic nailing led to better outcomes compared to hip spica casting in terms of earlier union, lower rates of malunion, shorter rehabilitation milestones, and better functional outcome scores.