Unstable forearm and femoral shaft fractures in children. Comparison between conservative treatment and intramedullary nailing

Elastic intramedullary nailing represents a new surgical concept in the tre atment of unstable shaft fractures in children. The present case control st udy wanted to examine the superiority of intramedullary nailing in comparis on to conservative therapeutic concepts which had been applied so far. 13 c hildren with forearm fractures who were treated initially by conservative m easures were compared to 13 other children who received a primary intramedu llary nailing. With femoral fractures, 12 children were included in each gr oup, in each patient pair age, type and localisation of the fracture were c omparable. During the observation period (until the termination of final th erapeutic measures or until the third year after injury) we examined clinic al variables and subjective findings. Both therapeutic concepts led to comp arably good functional results. Also subjective judgement of the therapeuti c success did not differ between groups. However, with intramedullary naili ng of shaft fractures of the femur the mean hospital length of stay (7.0 +/ - 3.5 days) was significantly shorter than with initial conservative treatm ent (36.5 +/- 2.2 days, P < 0.05). Irrespective of the localisation of the fracture intramedullary nailing required significantly less x-ray examinati ons during the observation period. These results suggest intramedullary nai ling to be the procedure of choice to treat unstable forearm and femoral fr actures in children.