title: An observational cohort study of the adoption of elastic stable intramedullary nailing for the treatment of pediatric femur fractures in Kumasi, Ghana.
abstract: BACKGROUND
  In high- and middle-income countries, elastic stable intramedullary nailing (ESIN) is the commonest treatment of femur fractures in children 5-11 years of age. At Komfo Anokye Teaching hospital (KATH) in Kumasi, Ghana, prior to this study all pediatric femur fractures were treated with skin traction to union. This study was designed to report the early results and costs of the adoption of ESIN at KATH to provide data to other low- and middle-income sites considering adoption of this surgical technique.
  
  
  METHODS
  An observational cohort study that included 84 pediatric patients ages 3-14 years presenting with closed femur fractures and treated with either skin traction or ESIN. Multivariate logistic regression was used to compare the rate of treatment success between treatment groups.
  
  
  RESULTS
  Treatment success (coronal and sagittal angulation less than 10 ° and shortening less than 15 mm at osseous union) was achieved in 92 % of the ESIN group versus 67 % of the skin traction group (odds ratio for ESIN group 9.28 (1.6-54.7); p = 0.0138). Average length of stay was significantly lower in the ESIN group (p = 0.001), but charges to patients were higher in the ESIN group (p < 0.001) because of the high cost of implants.
  
  
  CONCLUSIONS
  The initial experience of operative treatment of femoral shaft fractures in children using ESIN was positive, with improved rates of treatment success and no surgical complications. Because of the high cost of implants, direct costs of treatment remained higher with ESIN despite reductions in length of hospital stay.
authors: Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA, kaisersp@orthosurg.ucsf.edu.
authors: Scott P
authors: SP
authors: Kaiser
authors: Tai
authors: T
authors: Holland
authors: Paa Kwesi
authors: PK
authors: Baidoo
authors: Richard C
authors: RC
authors: Coughlin
authors: Peter
authors: P
authors: Konadu
authors: Dominic
authors: D
authors: Awariyah
authors: Raphael A
authors: RA
authors: Kumah-Ametepey
mesh_terms: D000293:Adolescent; D001858:Bone Nails / Q000191:economics; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005264:Femoral Fractures / Q000601:surgery* / Q000628:therapy; D005594:Fracture Fixation, Intramedullary / Q000191:economics* / Q000295:instrumentation; D017102:Fracture Healing; D005869:Ghana; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D014143:Traction / Q000191:economics*; D016896:Treatment Outcome