Evaluation of short-term clinical outcomes following closed intramedullary fixation with titanium elastic nails in displaced Paediatric femoral shaft fractures

Background: Femoral shaft fractures are common pediatric injuries, especially in children aged 5 to 15 years, often resulting from high-energy trauma. While conservative treatments like traction and casting are suitable for younger children, they pose challenges in older patients due to prolonged immobilization. Surgical management particularly closed intramedullary fixation with Titanium Elastic Nails (TENs), has become the preferred approach for displaced fractures due to its minimally invasive technique, stability, and favorable outcomes. TENs enable early mobilization and high union rates, though complications such as nail prominence and malalignment exist. Aim of the study: The study aims to evaluate the short-term clinical outcomes following closed intramedullary fixation using titanium elastic nails. Methods: This prospective observational study was conducted over 12 months, from January to December 2024 at the Department of Ortho Surgery in Rangpur Medical College Hospital, Rangpur, Bangladesh, involving 30 pediatric patients aged 5–14 years with displaced femoral shaft fractures. Eligible patients underwent closed reduction and intramedullary fixation using Titanium Elastic Nails (TENs). Surgery was performed under anesthesia using standardized techniques and fluoroscopic guidance. Postoperative care included early mobilization and non-weight-bearing ambulation. Data on demographics, injury characteristics, surgical details, complications, radiological union, and functional outcomes at 12 weeks were collected using a structured form. Using modified Flynn's criteria, outcomes were assessed based on time to union, complications, and clinical evaluation. Results: In this study of 30 pediatric patients with displaced femoral shaft fractures treated using Titanium Elastic Nails, the mean age was 9.4 ± 2.5 years, with males comprising 70% of cases. Most fractures occurred on the right side (60%) due to falls (66.7%). Transverse midshaft fractures were the most common. Radiological union was achieved within 8 weeks in 53.3% of patients and by 10 weeks in 36.7%. Postoperative complications were minimal, with nail protrusion (10%), infection (6.7%), and minor deformities (3.3%). At 12 weeks, 80% had excellent functional outcomes, 16.7% satisfactory, and only 3.3% poor, indicating favorable short-term recovery. Conclusion: Titanium Elastic Nailing is a safe, effective, and minimally invasive treatment for displaced pediatric femoral shaft fractures. It offers excellent short-term outcomes with low complication rates. Its suitability for low-resource settings like Bangladesh highlights its value as an ideal approach for pediatric orthopedic trauma in similar developing contexts.