Abstract Objective: This study aims to assess the efficacy of traction (plaster), intramedullary nail, plate, and external fixation in treating femoral shaft fractures in children using network meta-analysis to guide clinical decision-making. Methods: From inception to April 29, 2022, PubMed, EMbase, Cochrane Library, and Web of Science databases were searched for RCTs and cohort studies comparing treatments for femoral shaft fractures. STATA15.1 and Review Manager 5.4 software were used for data synthesis and quality evaluation. Results: Finally, 29 studies were included. Network meta-analysis findings: (1) Traction (plaster), external fixation, and intramedullary nailing were superior to plate in operation length. (2) External fixation had the best outcomes in hospital stays, with no statistically significant differences among treatments. (3) Intramedullary nailing showed significant superiority over plate in blood loss. (4) Intramedullary nailing had the best Flynn score efficacy, but the differences were not statistically significant. (5) Intramedullary nailing and plate had significantly fewer adverse events than external fixation and traction (cast). Conclusion: Comparing intramedullary nailing to traction (plaster), external fixation, and plate may enhance clinical outcomes of femoral shaft fractures in children. Intramedullary nailing may also reduce blood transfusion requirements and postoperative complications.
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Zhao et al. (2024) studied this question.
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