Meta-analysis demonstrates distinct complication and recovery patterns between surgical and non-surgical approaches in pediatric femoral fractures, highlighting the need for tailored treatment.
Pediatric femoral shaft fractures can be managed using both surgical and non-surgical strategies, with treatment selection influenced by age, body weight, fracture stability, and associated injuries. This systematic review and meta-analysis aim to compare radiological, complication, and recovery-related outcomes of these approaches. Peer-reviewed comparative studies evaluating hip-spica casting, traction, elastic stable intramedullary nailing, titanium elastic nailing system, plating, external fixation, and other operative techniques will be identified through major electronic databases following PRISMA 2020 principles. Outcomes of interest include time to radiological union, delayed union, nonunion, malalignment, malunion, limb-length discrepancy, infection, refracture, hardware-related complications, reoperation, hospital stay, and time to weight bearing. Available evidence suggests that both conservative and operative strategies can achieve satisfactory healing when appropriately selected, although complication profiles and recovery patterns vary. Treatment should therefore be individualized according to patient and fracture characteristics, while higher-quality comparative studies remain necessary to strengthen evidence-based recommendations.
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Shehzad et al. (2026) studied this question.