Titanium elastic nail in femur fractures as an alternative to spica cast in preschoolers.

Abstract

Titanium elastic nail (TEN) as an alternative to traction and spica cast in preschool children has not been widely studied for its safety and effectiveness. A cohort of 59 children with 59 fractures (non-pathological; not involving condyles or cervicotrochanteric area) were retrospectively examined. Their mean age was 4.5 ± 0.9 years and their mean weight was 14.5 ± 3.7 kg. All but five were closed (21 transverse, 19 oblique and 19 spiral). Thirty-five were caused by motor vehicle accidents and 24 by falls. There were six upper third, 27 upper-middle junction, 14 middle third, seven lower-middle junction, and five lower third fractures. The mean follow-up was 41.8 ± 4.3 months, the mean hospital stay was 1.3 ± 0.87 days, and the mean time to nail removal was 20.3 ± 10.2 weeks. The mean time to union was 7.6 ± 1.5 weeks. Union was significantly correlated to age (p = 0.000) and fracture shape (p = 0.005), but not to the fracture level, nature, or mechanism. Shortening of ≥1.0 cm occurred in two cases (3.4 %), with an overall mean of 0.06 ± 0.21 cm. Shortening was significantly correlated to the fracture shape (p = 0.020), but not to the level. Overgrowth of ≥1 cm occurred in seven cases (11.9 %), with an overall mean of 0.22 ± 0.41 cm. Overgrowth was insignificantly correlated to the fracture level and shape. Frontal angulation of 5-9º occurred in six cases (10.2 %) and sagittal angulation of 3-7º occurred in seven cases (11.9 %). A rotational deformity of 10º occurred in two cases (3.4 %). Five cases had a painful nail end (8.5 %) and exteriorization with superficial infection occurred in two cases (3.4 %). TEN is a dependable, safe, and cost-effective alternative to traction and cast in preschool children.