Elastic nailing versus plate and screws fixation for pediatric femoral shaft fractures: a systematic review and meta-analysis of high quality randomized controlled trials.

INTRODUCTION

Femoral shaft fractures are the most common pediatric femoral injury, accounting for 64%-68% of cases in children under 18 years. While younger children are usually treated non-surgically, older children often require fixation. Elastic stable intramedullary nailing (ESIN) and plating are the two main surgical options, but the optimal method remains debated.

METHODS

This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO. Medline/PubMed, ScienceDirect, Scopus, and Embase were searched for randomized controlled trials (RCTs) comparing ESIN and plating in patients ≤18 years with diaphyseal femoral fractures. Two reviewers independently extracted data, and study quality was assessed using the Cochrane Risk of Bias 2 tool. Meta-analyses were performed in RevMan 5.4.1 using random-effects models with significance set at P < 0.05.

RESULTS

Six RCTs including 364 children (182 ESIN, 182 plating) were analyzed. ESIN significantly reduced operative time (MD -36.76 min, P = 0.03) and blood loss (MD -94.77 mL, P < 0.00001) compared with plating. No significant differences were found in fracture union (MD -1.30 weeks, P = 0.16) or hospital stay (MD -3.80 days, P = 0.18). ESIN was associated with implant-related irritation, while plating showed higher risks of deep infection and postoperative stiffness.

CONCLUSIONS

ESIN offers shorter operative time and less blood loss but presents different complications compared with plating. Larger multicenter RCTs with extended follow-up are needed for definitive guidance.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251111355, PROSPERO CRD420251111355.