Evaluation of Titanium Elastic Nailing System in Pediatric Femoral Shaft Fractures: An Observational Study

Abstract Background: Femoral shaft fractures are common in the pediatric population, and the Titanium Elastic Nailing System (TENS) has emerged as a preferred surgical treatment option due to its minimally invasive nature and favorable outcomes. Objective: To assess the clinical and radiological outcomes, functional results, and complications associated with TENS fixation in the treatment of pediatric femoral shaft fractures. Methods: This prospective observational study included 60 children (38 males, 22 females), aged 5–15 years, who underwent TENS fixation for femoral shaft fractures at [Insert Hypothetical Tertiary Care Center Name and Location] between January 2020 and December 2023. Collected data included demographics, fracture type (AO/OTA classification), surgical details (nail diameter, entry point), radiological outcomes (union time, alignment), clinical outcomes (hospital stay, time to weight-bearing), and complications (infection, malunion, refracture, limb length discrepancy, hardware issues). Results: The mean age of the patients was 8.7 years (range: 5-15 years). Road traffic accidents (45%, n=27) and falls from height (35%, n=21) were the most common mechanisms of injury. According to the AO/OTA classification, the most frequent fracture type was 32-A1 (simple spiral, 40%, n=24). The mean time to radiographic union was 8.2 weeks (range: 6-14 weeks). Full weight-bearing was achieved at a mean of 4.5 weeks (range: 2-8 weeks) post-operatively. The mean length of hospital stay was 3.1 days (range: 2-6 days). The overall complication rate was 11.7% (n=7), including superficial pin site infection (5%, n=3), limb length discrepancy of >1 cm (3.3%, n=2), and delayed union (>16 weeks, 3.3%, n=2). No cases of deep infection, non-union, refracture, or nail breakage were observed. Conclusion: TENS fixation is a safe and effective option for most pediatric femoral shaft fractures, offering reliable union, early weight-bearing, and low complication rates. Optimal outcomes depend on proper patient selection and surgical technique.