title: Titanium elastic nailing versus hip spica cast in treatment of femoral-shaft fractures in children.
abstract: 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
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Medical Students Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. hamidrezashemshaki@yahoo.com
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Shemshaki
authors.forename: Hamid
authors.initials: H
authors.lastname: Mousavi
authors.forename: Ghasem
authors.initials: G
authors.lastname: Salehi
authors.forename: Mohammad Amin
authors.initials: MA
authors.lastname: Eshaghi
mesh_terms: D001858:Bone Nails; D002370:Casts, Surgical; D002648:Child; D005260:Female; D005264:Femoral Fractures / Q000601:surgery* / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D016059:Range of Motion, Articular; D020127:Recovery of Function; D014025:Titanium; D014143:Traction / Q000379:methods; D016896:Treatment Outcome; D016138:Walking
chemical_list: D014025:Titanium