Is Adolescent Age a Contraindication to Titanium Elastic Nailing for Femoral Shaft Fractures? A Retrospective Comparative Study

BACKGROUND: Titanium elastic nailing system (TENS) is widely used for pediatric femoral shaft fractures in school-age children, but its use in adolescents remains debated because greater age and body weight may increase mechanical demand on the elastic construct. This study compared outcomes of TENS in children aged 5-11 years and adolescents aged 12-16 years with isolated closed femoral shaft fractures. MATERIALS AND METHODS: This retrospective comparative study reviewed existing hospital records and serial radiographs of 39 patients treated with TENS between January 2022 and December 2024. Patients were grouped as 5-11 years (Group A, n = 25) and 12-16 years (Group B, n = 14). Demographic profile, fracture characteristics, operative variables, union, weight-bearing, alignment, limb-length discrepancy, complications, range of motion, and Flynn outcome were analyzed at a minimum 1-year follow-up. RESULTS: Union was achieved in all patients. The mean time to union was 10.8 ± 1.7 weeks in Group A and 11.4 ± 1.9 weeks in Group B (P = 0.310). The mean time to full weight-bearing was 11.9 ± 2.1 and 12.6 ± 2.3 weeks, respectively (P = 0.340). Excellent or satisfactory Flynn outcome was achieved in 24 (96.0%) patients in Group A and 13 (92.9%) patients in Group B (P = 0.640). No patient required revision fixation, conversion to plating, or unplanned major surgery. CONCLUSION: TENS provided reliable union and comparable 1-year outcomes in both the age groups. In carefully selected adolescents with isolated closed femoral shaft fractures, TENS remains an effective, minimally invasive and cost-conscious fixation option; age alone should not be considered a contraindication.