Intramedullary Nailing Compared with Spica Casts for Isolated Femoral Fractures in Four and Five-Year-Old Children

Femoral diaphyseal fractures are the most common major pediatric injuries treated by the orthopedic surgeon [1]. They represent about 1-2 % of all bony injuries in children [2]. Seventy percentage of femoral fractures involve the shaft [3]. The cause of these injuries varies with age; in preschool children the most common mechanism is a fall from a height. In children aged 4-12 years accidental injury during sport is the predominant cause [4]. A vast majority of femur fractures in children heal without any longterm sequelae [4]. With better understanding of biology of fracture healing and with advances in fixation methods and operative techniques, there has been a general trend toward operative stabilization of femoral shaft fractures in children. Operative treatment options for femoral fractures in children include plating, rigid intramedullary nailing, flexible intramedullary nailing, and external fixation. However, Martinez [5] reported excessive shortening and angular deformity in around 43 % of their patients treated by an early spica cast. Hughes [6] studied the impact of immediate spica casting on patients and families following femoral shaft fractures. They found that the greatest problems encountered by the family in caring for a child in a spica cast were transportation, cast intolerance by the child, and keeping the child clean [4-6]. Although most authors still recommend conservative methods of treatment in pediatric femur fractures in preschool children, there is still confusion regarding the optimal method for children beyond this age group [7]. In this study we compare two main methods in the treatment of isolated femoral fractures in four and five years old children which are intramedullary nailing and spica casts to assess the best method of management of femoral fractures in this age (Table 1). Abstract