Titanium Elastic Nailing Versus Hip Spica Cast in the Treatment of Femoral Shaft Fractures in Children.

Objective The objective of this study is to compare titanium elastic nailing (TEN) to hip spica casting (HSC) in the treatment of paediatric femoral shaft fractures, focusing on hospital stay duration and time to initiation of weight bearing. Study design This was a quasi-experimental study conducted at the Department of Orthopaedic Surgery, Benazir Bhutto Hospital, Rawalpindi, over a six-month period. Duration and place of study The data for this study were collected at the Department of Orthopaedic Surgery, Benazir Bhutto Hospital, a major tertiary care and trauma referral centre, over a six-month period from 8 August 2018 to 8 February 2019. Patients and methods A total of 60 children aged 6-12 years with femoral shaft fractures were enrolled using consecutive sampling and divided into two groups based on the treatment provided by the consultant orthopaedic surgeon. Group A (n=30) received titanium elastic nailing, while Group B (n=30) underwent early hip spica casting after initial skin traction. Follow-ups were conducted at two, four, six, eight and 12 weeks to evaluate hospital stay, time to weight bearing and bone healing. Clinical assessment included the range of motion and pain evaluation to guide weight bearing. Data were analysed using SPSS version 22 (IBM Corp., Armonk, NY); means and standard deviations were calculated for quantitative variables, and independent t-tests were used for group comparisons. Stratification was done for age, gender and fracture side, with a p-value of <0.05 considered statistically significant. Results In Group A (TEN group), the mean duration of hospital stay was 3.93±0.78 days, compared to 3.03±1.03 days in Group B (HSC group) (p<0.05). The time to start weight bearing was 30.57±6.81 days in Group A and 59.5±14.03 days in Group B (p<0.05). In the TEN group, surgery was typically performed within 48-72 hours of injury, depending on patient stabilisation and operating room availability. In the HSC group, hip spica casting was applied within 72 hours of injury following initial skin traction. Weight-bearing decisions in both groups were based on a combination of clinical evaluation, including the absence of pain on movement and the restoration of joint mobility, and the radiological evidence of bone healing, defined as callus formation on at least three out of four cortices on anteroposterior (AP) and lateral radiographs. Conclusion This study observed that titanium elastic nailing was associated with the earlier initiation of weight bearing compared to hip spica casting in children aged 6-12 years with femoral shaft fractures. As hip spica casting is more commonly recommended for younger children under five years of age, our findings suggest that titanium elastic nailing may be a more suitable option in older paediatric patients, particularly in settings where surgical infrastructure is available. While TEN demonstrated potential advantages in terms of earlier functional recovery, it is important to interpret these findings within the context of the study's focus on time to weight bearing and hospital stay.