Abstract
OBJECTIVE: This study aims to compare the effectiveness of ESIN versus SMPs in both length-stable and unstable fractures of the femoral diaphysis in children above five years of age. METHODS: A Prospective Comparative Study was done including 40 children aged 5-13 years with a displaced shaft of femur fracture. Patients were randomized with either elastic nailing or submuscular plating as one of the operating options and were operated on according to their unique hospital identification number. The mean blood loss, operative time, fluoroscopy time, duration of analgesic use, and complications in both groups were noted. At end of 12 months, the primary outcome as per Flynn's criteria, was evaluated. Minimum 2 year follow up was done to evaluate for any complications. RESULTS: 40 patients were available for the study, 22 in ESIN (group1) and 18 in SMP (group2). In the ESIN (group1), 16 patients (72.72 %) had excellent grade, 4 patients (18.18 %) had satisfactory grade, and 2 patients (9.09 %) had a poor grade. In the SMP group, 17patients (94.44 %) had excellent grade, and 1 patient (5.55 %) had a poor outcome. Surgical parameters such as the mean operative time, incision length, blood loss, mean fluoroscopy time was significantly shorter in ESIN group compared to the SMP group (<0.001). CONCLUSIONS: The outcome of fractures, irrespective of length stability managed by ESIN are comparable to SMP. Based on our findings, ESIN can safely be employed for management of length unstable fractures. The choice of implant should be based on surgeon's discretion, comfort level, patient decision and overall cost of the procedure, rather than on length stability of fracture.