Medical Students Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
J Orthop Traumatol. 2011 Mar;12(1):45-8. doi: 10.1007/s10195-011-0128-0. Epub 2011 Feb 22.
There is no consensus on treatment of closed femoral-shaft fractures in children. We compared hip spica cast with titanium elastic nailing (TEN) in the treatment of femoral-shaft fractures in children.
Forty-six children, 6-12 years old, with simple femoral-shaft fractures were randomized to receive skeletal traction followed by hip spica cast (n = 23) or TEN (n = 23). Length of hospital stay, time to start walking with aids, time to start independent walking, time absent from school, parent satisfaction, and range of knee motion were compared between the two groups 6 months after injury.
The two groups were similar in background characteristics. Compared with the children treated with spica cast, those treated with TEN had shorter hospital stay (P < 0.001) and took a shorter time to start walking with support or independently (P < 0.001), returned to school sooner (P < 0.001), and had higher parent satisfaction (P = 0.003). Range of knee motion was 138.7 ± 3.4° in the spica cast group and 133.5 ± 13.4° in the TEN group (P = 0.078). Three patients (13.0%) in the spica cast group compared with none in the TEN group had malunion (P = 0.117). Postoperative infection was observed in three patients (13.0%) in the TEN group.
The results showed significant benefits of TEN compared with traction and hip spica cast in the treatment of femoral-shaft fractures in children. Further trials with longer follow-ups and comparison of TEN with other methods, such as external fixation, in children's femoral fractures are warranted.
儿童闭合性股骨干骨折的治疗尚无共识。我们比较了儿童股骨干骨折的髋人字石膏固定与钛弹性钉（TEN）固定的疗效。
46 名 6-12 岁的单纯股骨干骨折患儿随机分为接受骨牵引后髋人字石膏固定（n = 23）或 TEN 固定（n = 23）。比较两组患儿的住院时间、辅助行走开始时间、独立行走开始时间、缺课时间、家长满意度以及膝关节活动范围。
两组患儿的背景特征相似。与接受人字石膏固定的患儿相比，接受 TEN 固定的患儿住院时间更短（P < 0.001），辅助行走或独立行走开始时间更早（P < 0.001），上学时间更早（P < 0.001），家长满意度更高（P = 0.003）。人字石膏固定组的膝关节活动范围为 138.7 ± 3.4°，TEN 固定组为 133.5 ± 13.4°（P = 0.078）。人字石膏固定组有 3 例（13.0%）患儿发生畸形愈合，TEN 固定组无患儿发生畸形愈合（P = 0.117）。TEN 固定组有 3 例（13.0%）患儿术后发生感染。
与牵引和髋人字石膏固定相比，TEN 治疗儿童股骨干骨折具有明显优势。需要进行更长时间随访的进一步试验，并比较 TEN 与儿童股骨干骨折其他治疗方法（如外固定）的疗效。
