Titanium elastic nailing may be better than hip spica casting for pediatric femoral fractures

Saseendar S. J Child Orthop. Published: Online April 2010.

Treating pediatric femoral fractures with titanium elastic nailing produced better outcomes, including earlier union and lower malunion rates, compared to hip spica casting, according to Indian researchers.

For their study, S. Saseendar and colleagues at the Jawaharlal Institute of Postgraduate Medical Education and Research assessed the effectiveness of titanium elastic nailing vs. traditional hip spica casting. During a 13-month period, the researchers recruited 16 children with femur fractures. The children ranged in age from 5 to 15 years. They retrospectively recruited an equal number of age-matched children who were treated with hip spica casting. The researchers excluded subtrochanteric, supracondylar femur fractures, according to the abstract.

Overall, Saseendar and colleagues found that the results were better for the surgical group compared to the spica group. Union occurred at 6 weeks in the surgical group compared to 8 weeks in the spica group (P=.001). The researchers also found that the spica group had significantly higher rates of coronal plane angulation, rotational malalignment and limb length discrepancy at 1-year follow-up. The spica group was immobilized longer than the surgical group and achieved full weight bearing later. In addition, the spica casting group had a significantly higher number of school absences.

“Flynn outcome scores were better with titanium elastic nailing than with hip spica casting,” the researchers wrote in their abstract.

This was a very small prospective study with results similar to many published series in the past 10 years. Surgeons in most areas of the developed world have adopted fixation for femoral shaft fractures in children older than 6 [years of age], for the reasons outlined in this paper.

– John M. Flynn, MD
Orthopedics Today Editorial Board Member