title: Titanium elastic nail in femur fractures as an alternative to spica cast in preschoolers.
abstract: OBJECTIVE
  Titanium elastic nail (TEN) as an alternative to traction and spica cast in preschool children has not been widely studied for its safety and effectiveness.
  
  
  METHODS
  A cohort of 59 children with 59 fractures (non-pathological; not involving condyles or cervicotrochanteric area) were retrospectively examined. Their mean age was 4.5 ± 0.9 years and their mean weight was 14.5 ± 3.7 kg. All but five were closed (21 transverse, 19 oblique and 19 spiral). Thirty-five were caused by motor vehicle accidents and 24 by falls. There were six upper third, 27 upper-middle junction, 14 middle third, seven lower-middle junction, and five lower third fractures.
  
  
  RESULTS
  The mean follow-up was 41.8 ± 4.3 months, the mean hospital stay was 1.3 ± 0.87 days, and the mean time to nail removal was 20.3 ± 10.2 weeks. The mean time to union was 7.6 ± 1.5 weeks. Union was significantly correlated to age (p = 0.000) and fracture shape (p = 0.005), but not to the fracture level, nature, or mechanism. Shortening of ≥1.0 cm occurred in two cases (3.4 %), with an overall mean of 0.06 ± 0.21 cm. Shortening was significantly correlated to the fracture shape (p = 0.020), but not to the level. Overgrowth of ≥1 cm occurred in seven cases (11.9 %), with an overall mean of 0.22 ± 0.41 cm. Overgrowth was insignificantly correlated to the fracture level and shape. Frontal angulation of 5-9º occurred in six cases (10.2 %) and sagittal angulation of 3-7º occurred in seven cases (11.9 %). A rotational deformity of 10º occurred in two cases (3.4 %). Five cases had a painful nail end (8.5 %) and exteriorization with superficial infection occurred in two cases (3.4 %).
  
  
  CONCLUSIONS
  TEN is a dependable, safe, and cost-effective alternative to traction and cast in preschool children.
authors.affiliation: Orthopaedic Department, Faculty of Medicine, Sohâg University, Sohâg, 82425 Egypt.
authors.forename: Yasser M
authors.initials: YM
authors.lastname: Assaghir
keywords: Elastic stable intramedullary nail; Femur fractures; Preschool children; Preschoolers; Titanium elastic nail