title: Femoral shaft fractures in children: traction and casting versus elastic stable intramedullary nailing.
abstract: BACKGROUND
  Treatment of pediatric femoral fractures by 90/90 traction and spica casting (TXN/CST) has begun to be replaced by elastic stable intramedullary nailing (ESIN). The purpose of our study was to perform a cost analysis of TXN/CST versus ESIN in addition to comparing clinical/functional parameters.
  
  
  METHODS
  We reviewed all children admitted with femoral shaft fractures between January 1995 and April 1998. Overall cost and clinical/radiographic outcome measures were analyzed, and 60% of patients' parents completed a follow-up telephone interview. Sixty-eight patients representing 71 femoral shaft fractures that had complete data and 1-year follow-up were included.
  
  
  RESULTS
  No difference existed between the two groups for standard clinical/functional criteria. ESIN was associated with a lower overall cost than TXN/CST. ESIN also resulted in better scar acceptance, and higher overall parent satisfaction.
  
  
  CONCLUSIONS
  Less cost and comparable clinical outcome make ESIN a better option than traditional TXN/CST for femoral fracture care in the skeletally immature patient.
authors.affiliation: Big Sky Orthopaedic Specialists, Missoula, Montana, USA.
authors.forename: Karl E
authors.initials: KE
authors.lastname: Buechsenschuetz
authors.forename: Charles T
authors.initials: CT
authors.lastname: Mehlman
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Shaw
authors.forename: Alvin H
authors.initials: AH
authors.lastname: Crawford
authors.forename: Elisa B
authors.initials: EB
authors.lastname: Immerman
mesh_terms: D000293:Adolescent; D001858:Bone Nails; D002370:Casts, Surgical / Q000191:economics; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005260:Female; D005264:Femoral Fractures / Q000628:therapy*; D005594:Fracture Fixation, Intramedullary / Q000191:economics / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D014143:Traction / Q000191:economics; D016896:Treatment Outcome