The Open Orthopaedics Journal

ISSN: 1874-3250 ― Volume 13, 2019

Diaphyseal Femoral Fractures in Children: Comparison Between Elastic Stable Intramedullary Nailing and Conservative Management

Las J. Hwaizi1, *, Areewan MS. Saeed2, Mustafa N. Mahmood2
1 Assistant professor, Department of Orthopedic Surgery, College of Medicine, Hawler Medical University, Hawler, Kurdistan Region, Iraq
2 Lecturer, Department of Orthopedic Surgery, College of Medicine, University of Sulaimani, Sulaimani, Kurdistan Region, Iraq



Femoral shaft fractures are one of the most common fractures of the lower extremities in children. Although many approaches and options are available for their treatment, the most appropriate treatment option for school going children is still debatable.


This study investigated the efficacy, safety, and outcome of surgical intervention with Elastic Stable Intramedullary Nailing (ESIN) in 3–12-year-old children with diaphyseal femoral fractures and compared them with those of conservative management.


In this prospective study, 41 children with diaphyseal femoral fractures were recruited between April 2013 and April 2016. The fractures were divided into two equal groups: one treated with ESIN, and the other with early spica casting or noninvasive traction followed by hip spica casting. Demographic data, clinical information, and serial radiographic findings were collected and compared between the two groups. Flynn’s scoring criteria pertaining to time to union, assisted weight bearing, independent ambulation, return to school, and complications were applied. Fischer’s exact test was used for statistical analyses.


Compared with spica casting-treated fractures, ESIN-treated fractures healed faster with lower average time to assisted weight bearing, independent ambulation, and return to school. Hip spica-treated children had a higher rate of major complications than ESIN-treated children. At 1-year follow-up, higher limb length discrepancy was reported in hip spica-treated children than in ESIN-treated children (P < 0.001).


ESIN is a safe and effective approach for treating femoral shaft fractures in children; it provides better functional and radiographic outcomes than spica casting and can be used in preschool-age children.

Keywords: Elastic stable intramedullary nail, Femur, Fracture, Pediatric, Hip spica, Femoral shaft fracture.

Article Information

Identifiers and Pagination:

Year: 2018
Volume: 12
First Page: 435
Last Page: 444
Publisher Id: TOORTHJ-12-435
DOI: 10.2174/1874325001812010435

Article History:

Received Date: 6/4/2018
Revision Received Date: 2/10/2018
Acceptance Date: 8/10/2018
Electronic publication date: 31/10/2018
Collection year: 2018

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© 2018 Hwaizi et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Orthopedic Surgery,, College of Medicine, Hawler Medical University,, Hawler, Kurdistan Region, Erbil 44001, Iraq; Tel: +9647504460656; E-mail:


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