A Comparative Study of the Radiological and Functional Outcomes Between the Titanium Elastic Nailing System and Long-Leg Cast Immobilization in Pediatric Femoral Shaft Fractures: A Retrospective Study

Background: Pediatric femoral shaft fractures are common injuries that can cause significant morbidity and functional impairment if not treated properly. Traditionally, long-leg cast immobilization has been employed; however, prolonged immobilization may lead to joint stiffness, muscle atrophy, limb-length discrepancy, and delayed functional recovery. The titanium elastic nailing system (TENS) provides elastic, stable intramedullary fixation, promotes biological healing, and enables early mobilization. This study compared radiological union, limb length discrepancy, callus formation, pain, range of motion, and complications between TENS fixation and long-leg cast immobilization. Methods: A retrospective comparative study was conducted involving 60 children aged 5-14 years with diaphyseal femoral fractures treated either with the TENS fixation (n = 30) or long-leg cast immobilization (n = 30). Patients with pathological fractures, open fractures, polytrauma, neuromuscular disorders, or incomplete follow-up were excluded. Follow-up assessments were performed at one, three, and six months, with the final evaluation at six months. Radiological union was assessed using the modified Radiographic Union Scale for Tibial (RUST) fractures score. Limb length discrepancy, callus formation, pain (measured by the Visual Analog Scale), hip and knee range of motion, and complications were also evaluated. Results: The TENS group demonstrated significantly earlier radiological union (11.2 ± 1.6 vs. 15.8 ± 2.3 weeks; p < 0.001) and higher modified RUST scores at six months. Limb length discrepancy and pain scores were significantly lower in the TENS group. Hip and knee range of motion were superior in the TENS group at the final follow-up. Delayed union occurred in one patient (3.3%) in the TENS group compared with six patients (20%) in the cast group. Cast-related skin complications were observed in five patients (16.7%) in the cast group, while implant irritation occurred in two patients (6.7%) in the TENS group and was managed conservatively. Conclusion: TENS fixation is an effective treatment option for pediatric femoral shaft fractures, offering earlier radiological union, enhanced functional recovery, and fewer complications related to immobilization than long-leg cast immobilization.