Elastic Nail vs Hip Spica Cast in Early Rx of Pediatric Femo
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Introduction
Femoral shaft fractures are among the most common pediatric injury, which have the highest incidence among other pediatric fractures, and treatment of them carries a lot of controversies.

Aim of the study
To compare the outcome of fixation of femoral shaft fracture by elastic nail with Spica cast.

Patient and method
This prospective comparative study was carried out in Sulaimani Teaching Hospital, in the period from the 10th of December 2011 to the 10th of June 2012, for two groups of children whose ages were between 4 - 12 years (average 6.61 years), sustained traumatic femoral shaft fractures with follow-up period of about 6 months. The first group was consisting of 30 children treated by Elastic Intramedullary Nail, while the second group was consisted of 30 children treated by hip Spica. The selection was made on random bases.

Results
Age range was between 4 - 12 years and showed male predominance in both groups with ratio of about 2:1 while fracture site showed predominance of the midshaft pattern in both groups. This study showed highly significant deference (P value of 0.001) between the two groups (Spica group of 3 days versus Nail group median of rate 4.5 days) in the admission period. Our sample showed shortening of about 2 cm in 2 case in the Nail group (6.7%) versus 6 cases (20%) in Spica group. We reported 4 cases of wound infection (13.3%) and 4 cases of pin site irritation (13.3%) in nail group. A higher rate of malunion was observed in the Spica group (10 cases more than 10? angulation in coronal plane) while the Nail group reported 2 case more than 10? in coronal plane. The mean operative time for Nail group was 55 minutes while in Spica group was 30 minutes. We reported shorter time to start mobilization and walking with support or independently in the nail group (weight bearing time 7.2 weeks) compared with the Spica casting group (weight bearing time 7.5 weeks).

Conclusion
Elastic nail fixation yields better outcome for femoral shaft fracture in form of easier child handling, parent’s satisfaction, and maintaining acceptable fracture alignment.

https://goo.gl/BreOap
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