External Fixation vs. Flexible Intramedullary Nailing for Femoral Shaft Fractures in Children: A Prospective Randomized Study (Code-T0155)

Introduction: Femoral shaft fractures in children are common and typically require surgical intervention. The choice of fixation method remains controversial, with external fixation and flexible intramedullary nailing (FIN) being two commonly used approaches. Both techniques have advantages and limitations, and a direct comparison of their outcomes in pediatric femoral fractures is necessary for better clinical decision-making.

To compare the efficacy and the outcomes of two operative interventions used for diaphyseal pediatric femur fracture fixation namely elastic intramedullary nailing and external fixation

Objectives:

To compare prospectively between two interventions (Elastic stable intramedullary nailing and External fixation) using the following outcomes:

i. Malunion - As per assessment at the end of 1st 3rd, 6th and 12th months

ii. Serious adverse effects namely

a) Non-union

b) Infection deep surgical wound infection

c) Reoperation

d) Nerve injuries

Aims and Objectives:

Methods: A total of 60 children aged 5-15 years with femoral shaft fractures were randomly assigned to receive either external fixation (Group A) or flexible intramedullary nailing (Group B). Fracture healing time, complications (such as infection, malunion), functional outcomes (assessed using the functional scoring system), and duration of hospital stay were recorded. Follow-up evaluations were conducted at 3, 6, and 12 months post-surgery.

Results: Both groups showed good outcomes in terms of fracture healing, with no significant differences in healing time. However, Group B (flexible intramedullary nailing) had a significantly lower incidence of complications such as infection and malunion compared to Group A (external fixation). The duration of hospital stay was shorter in the FIN group. Functional outcomes were excellent in both groups, with no major differences between them.

Conclusion: Flexible intramedullary nailing provides superior outcomes in terms of fewer complications and a shorter hospital stay compared to external fixation for femoral shaft fractures in children. Both methods, however, are effective, and the choice of treatment should depend on fracture characteristics and surgeon expertise.

Keywords: Femoral shaft fracture, External fixation, Flexible intramedullary nailing, Pediatric fractures, Complications, Functional outcomes.