Submuscular locked compression plating and elastic stable intramedullary nailing for children with diaphyseal fractures of femur: An open labelled randomized controlled trial

Abstract

Objectives: To conduct a comparative evaluation of submuscular locked compression plating (SLCP, intervention) and elastic stable intramedullary nailing (ESIN, control) among children 5 to 15 years of age with diaphyseal fractures of femur. Methods: This was a hospital based open labelled randomized controlled trial conducted among children presenting with diaphyseal fractures of femur in the Department of Pediatric Orthopedics of a tertiary healthcare facility in south India between January 2018 and December 2018. Results: The present study included a total of 60 children – 30 children were treated with SLCP and the other 30 were treated with ESIN. None of the patients in either the intervention or the control arm developed malunion, deep surgical wound infections, or nerve injuries or compartment syndrome. 10.0% patients had loss of reduction post-surgery due to trivial fall requiring closed reduction, and 16.7% reported joint stiffness in the ESIN (control) arm. The mean (SD) global function scores in PODCI scale and subscale scores (upper extremity and physical function, transfers and basic mobility, sports and physical function, pain and comfort) among patients in the intervention arm was significantly higher than that reported among patients in the control arm. Though the happiness scores were significantly higher among patients in the intervention arm (p<0.05), no significant difference between intervention and control arms was found in terms of expectations (p>0.05). Duration of hospital stay, time taken for union, and blood loss (in ml) did not vary significantly between the study groups (p>0.05). However, the duration of radiation required was significantly shorter among patients in the intervention arm in comparison with the control arm. Conclusion: While both SLCP and ESIN are viable treatment options for diaphyseal femur fractures in children, SLCP appears to offer distinct advantages in terms of functional outcomes and patient happiness. Moreover, the reduced radiation exposure associated with SLCP is a notable benefit.