Comparative study of titanium elastic nailing versus hip spica in treatment of femoral shaft fractures in children

Dharam Pal Verma, Rahul Kumar Chandan, R. C. Meena, S. L. Sharma


Background: 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.

Methods: Study was conducted at SMS Medical College, Jaipur (Rajasthan). Out of 90 Patients of diaphyseal fracture femur, 45were treated conservatively by spica cast and 45 were treated with TEN. Follow up done regularly up to twelve months of injury with taking into account, various parameters.

Results: All diaphyseal fractures of femur healed, whether treated conservatively by spica cast or treated operatively with TEN. The time of union and weight bearing was less in operative group as comparative to spica cast group. Ten patients (22.22%) in spica group compared to three patients (6.66%) in operative group had malunion and two patients (4.4%) in spica group compared none in operative group had delayed union.

Conclusions: Results of TEN turned out to be far superior to traction and spica cast treatment in paediatric femoral fractures. Rate of complications was far low with operative than conservative Treatment.


Spica cast, Titanium elastic nailing, Femoral-shaft fracture, Pediatrics

Full Text:



Hinton RY, Lincoln A, Crockett MM, Sponseller P, Smith G. Fractures of the femoral shaft in children. Incidence, mechanisms, and sociodemographic risk factors. J Bone Joint Surg Am. 1999;81:500–9.

Buess E, Kaelin A. One hundred pediatric femoral fractures: epidemiology, treatment attitudes, and early complications. J Pediatr Orthop B. 1998;7:186–92.

Wall EJ, Jain V, Vora V, Mehlman CT, Crawford AH. Complications of titanium and stainless steel elastic nail fixation of pediatric femoral fractures. J Bone Joint Surg Am. 2008;90(6):1305–13.

Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J. Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications. J Pediatr Orthop. 2001;21:4–8.

Flynn JM, Luedtke LM, Ganley TJ, Dawson J, Davidson RS, Dormans JP, et al. Comparison of titanium elastic nails with traction and a spica cast to treat femoral fractures in children. J Bone Joint Surg Am. 2004;86:770–7.

Buechsenschuetz KE, Mehlman CT, Shaw KJ, Crawford AH, Immerman EB. Femoral shaft fractures in children: traction and casting versus elastic stable intramedullary nailing. J Trauma. 2002;53:914–21.

Wright JG. The treatment of femoral shaft fractures in children: a systematic overview and critical appraisal of the literature. Can J Surg. 2000;43:180–9.

Ligier JN, Metaizeau JP, Prevot J. Closed flexible medullary nailing in pediatric traumatology. Chir Pediatr. 1983;24:383–5.

Reeves RB, Ballard RI, Hughes JL. Internal fixation versus traction and casting of adolescent femoral shaft fractures. J Pediatr Orthop. 1990;10:592–5.

Greisberg J, Bliss MJ, Eberson CP, Solga P, d’Amato C. Social and economic benefits of flexible intramedullary nails in he treatment of pediatric femoral shaft fractures. Orthopedics. 2002;25:1067–70

Herndon WA, Mahnken RF, Yngve DA, Sullivan JA. Management of femoral shaft fractures in the adolescent. J Pediatr Orthop. 1989;9:29–32.

Saseendar S, Menon J, Patro DK. Treatment of femoral fractures in children: is titanium elastic nailing an improvement over hip spica casting. J Child Orthop. 2010;4:245–51.

Kirby RM, Winquist RA, Hansen ST Jr. Femoral shaft fractures in adolescents: a comparison between traction plus cast treatment and closed intramedullary nailing. J Pediatr Orthop. 1981;1:193–7.

Aronson J, Tursky EA. External fixation of femur fractures in children. J Pediatr Orthop. 1992;12:157–63.