Umar Zia Khan, Mian Amjad Ali, Faaiz Ali Shah.
Paediatric Femur Fracture; Retrograde Elastic Intramedullary Nails Versus Immediate HIP SPICA Cast in Treatment of Paediatric Femur Fracture: a Prospective, Randomized Study.
Professional Med J Jan ;25(5):639-42.

Objectives: To evaluate the outcome of retrograde flexible intramedullary nails in treatment of paedriatic diaphyseal fractures in comparison with the traditional treatment of immediate hip spica cast. Hypothesis: We hypothesised that in children with femur fracture who are managed with flexible intramedullary nails have better outcome in comparison to those managed with immediate hip spica cast. Study Design: Randomized control trail. Place & Duration of Study: Lady Reading Hospital, Peshawar from June 2016 to October 2017. Methods: A group of forty-eight children aged 6-12 were randomly allocated either elastic intramedullary nail or immediate hip spica casting and were followed up to six months. Fracture alignment (coronal and sagittal angulation, leg length discrepancy), time for fracture union, recovery mile stones (time to start weight bearing with aids, independent walking, knee range of movement) and the presence of complications including surgical site infection were recorded and compared between two groups. Results: Children treated with elastic intramedullary nails in comparison with those treated with immediate hip spica had early union (p<0.001), shorter time to start weight bearing with support or independently (p<0.001). Leg Length discrepancy (p<0.001), coronal and sagittal angulation (p<0.001 and p=0.02) was significantly higher in hip spica group. Difference observed between the two groups regarding knee range of movement (p=0.085) and surgical site infection (p=0.076) was not significant. Conclusion: Children aged 6-12 years treated with elastic intramedullary nail for femoral diaphyseal fracture had earlier union, reduced rate of shortening, malunion and allowed earlier rehabilitation.

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