Elastic Stable Intramedullary Nailing (ESIN) versus Plating in Pediatric Subtrochanteric Femur Fractures

Background: Pediatric subtrochanteric femur fractures are uncommon but pose unique challenges due to the biomechanical forces acting on this region. Elastic Stable Intramedullary Nailing (ESIN) and Open Reduction Internal Fixation (ORIF) are widely used surgical techniques with distinct benefits and risks. Objectives: This study evaluates the comparative outcomes of ESIN and ORIF for pediatric subtrochanteric femur fractures, focusing on fracture healing, operative parameters, functional outcomes, and postoperative complications. Patients and methods: A prospective randomized study was conducted at Qena University Hospital involving 30 children aged 3–14 years with isolated subtrochanteric femur fractures. Participants were randomly assigned to ESIN (Group A) or ORIF (Group B). Outcomes, including operative time, blood loss, union rates, complications, and functional scores, were assessed at regular follow-ups. Results: ESIN demonstrated faster union (mean 5.2 ± 1.1 weeks) compared to ORIF (8.7 ± 2.3 weeks, p < 0.001). Operative duration and intraoperative blood loss were significantly lower in ESIN (p < 0.001). Complications, such as leg length discrepancies, were present in 20% of ORIF cases but absent in ESIN. Functional outcomes, based on Flynn’s criteria, favored ESIN. Conclusion: ESIN offers superior outcomes in pediatric subtrochanteric fractures, with faster healing, lower surgical morbidity, and fewer complications. ORIF remains an option for complex comminuted fractures.