Comparative Assessment of Elastic Intramedullary Nailing Versus Conventional Plate Fixation for Pediatric Femoral Shaft Fractures in the Emergency Setting.

AIM: This study aims to compare the clinical outcomes between elastic intramedullary nailing and traditional open reduction and plate fixation for pediatric femoral shaft fractures in the emergency setting.

METHODS

This retrospective study enrolled 313 pediatric patients with femoral shaft fractures who underwent emergency surgical treatment at Qinghai Provincial Women and Children's Hospital between January 2023 and February 2024. After propensity score matching (PSM), patients who received elastic stable intramedullary nailing were assigned to the observation group (n = 120), whereas those who were treated with traditional open reduction and plate fixation were included in the control group (n = 120). Perioperative data, postoperative knee function, range of motion, and incidence of complications were compared between the two groups.

RESULTS

Patients in the observation group demonstrated shorter operative times and smaller incision lengths than those in the control group. They also experienced reduced intraoperative blood loss and minimal fluoroscopic exposures, and achieved full weight-bearing earlier than those in the control group (p < 0.001). At both 3 and 6 months after surgery, knee function scores, knee range-of-motion scores, and total Hospital for Special Surgery (HSS) scores were higher in the observation group, along with improved knee stability score (p < 0.05). At 3 months postoperatively, the hip function score, hip range-of-motion score, and total Harris Hip score were also higher in the observation group (p < 0.01). Successful fracture union was achieved in all children, with no serious postoperative complications observed in either group. In the control group, two cases developed incision-site infections, which were cured after debridement and anti-infective treatment.

CONCLUSIONS

In the emergency setting, both elastic intramedullary nailing and conventional open reduction with plate fixation can achieve favorable clinical outcomes in children with femoral shaft fractures. Elastic intramedullary nailing offers distinct advantages, such as minimal surgical trauma, earlier postoperative weight-bearing, and better early recovery, rendering it a suitable option in this clinical setting.