Is Submuscular Plating as Effective and Safe as Elastic Stable Intramedullary Nailing for Pediatric Diaphysial Fractures of the Femur?

Objective: The aim of this study was to compare outcomes of submuscular plating (SMP) and elastic stable intramedullary nailing (ESIN) techniques in pediatric diaphysial fractures of the femur.We hypothesize that SMP technique is as safe and effective as ESIN technique for treating diaphysial fractures of the femur.Methods: Hospital database was searched for surgically treated diaphysial femur fracture patients between January 2018 and January 2022.Patients were separated into two groups.Group A (n=23) consisted of patients treated with SMP technique and Group B (n=26) consisted of patients treated with ESIN technique.Age, gender, injury mechanism, length of hospital stay, union, complications, shortening, operation time and surgical techniques were evaluated.In order to assess post-operative outcomes, criteria described by Flynn were used [9].In order to evaluate functional outcomes, hip and knee range of motion (ROM) were measured.Results: Median values of age, gender and injury mechanism distributions as well as mean hospital stay, union ratio, open reduction ratio and mean time of surgery were similar.Time to visible callus and subsequent mobilization was significantly less in group A (3.7 weeks) compared to group B (4.3 weeks).(p<0.001).Clinical, functional and radiological outcomes were statistically similar. Conclusion:Our study demonstrates that both SMP and ESIN methods provide high rates of union with satisfying clinical, radiological and functional outcomes.SMP is associated with earlier callus formation and patient mobilization.SMP technique may be as safe and as effective as ESIN technique for pediatric diaphysial fractures of femur.