Femoral shaft fractures in preschool children: external fixation and elastic intramedullary nail treatments in clinical practice

Surgical intervention in preschoolers with femoral shaft fractures has increased due to the evolving lifestyle. This study aimed to analyze and compare the efficacy of elastic intramedullary nailing and external fixation in treating femoral shaft fractures in children aged 2-5. Ninety-nine pediatric patients were categorized into the external fixator (EF) and the elastic intramedullary nail (ESIN) group based on surgical techniques. Data on follow-up, intraoperative parameters, postoperative complications, fracture features, and demographics were gathered and compared. The mean duration of follow-up was 32 months, ranging from 25 to 48 months. All fractures had healed completely and no instances of nonunion were observed. At the latest follow-up, within the EF group, there were instances of malunion, delayed union, and refracture, each occurring once. One case in every group exhibited a leg length difference above 2 cm. The external fixation group had a shorter operation duration ( P = 0.04), fewer intraoperative fluoroscopy times ( P < 0.01), earlier partial weight-bearing time ( P < 0.01), and full weight-bearing time ( P < 0.01), while a greater complication rate (29.8 vs. 14.3%, P = 0.07) compared with the ESIN group. The incidence of pin tract infection in the EF group was 21.1% (12/57) compared with 2.4% (1/42) in the ESIN group ( P = 0.07). Eighty percent of the patients' families expressed concern about the residual scar after removing the EF. The ESIN group encounters fewer complications and positive aesthetic effects, making it a preferable treatment option in this specific patient population and fracture pattern. Level of evidence: Class III, retrospective comparative study.