Comparative Study between Flexible Intramedullary Nail and Sub Muscular Plate in Treatment of Unstable diaphyseal Femoral Fracture

Background: Femoral shaft fractures are among the most frequent fractures that necessitate hospitalization. The treatment of juvenile femoral shaft fractures remains controversial, particularly when they are unstable.
Objectives The aim of this study was to compere between the flexible intramedullary nail and the submuscular plate in fixation of pediatric femoral shaft fractures at the age group between 5 and 12 years old with unstable femoral shaft fractures regarding clinical and radiological outcomes. Patients and Methods This prospective cohort study was conducted on 30 patients with unstable femoral shaft fractures aged from 5 to 12, between Feb. 2021 and Feb. 2024. They were randomly subdivided into two groups, group 1 (15 patients) treated by Flexible intra-medullary nails (FNs) and group 2 (15 patients) treated by SMPs. The assessment variables were intraoperative C-arm shots, blood loss, time for radiological union, malunion, leg length discrepancy, and Flynn’s score.
Results There was no statistically significant difference between the two groups regarding demographic data, C-arm shots, time for union, complications, the LLD, angular deformity, time for union, and Flynn’s score.The FNs group had a significantly lower estimated blood loss (EBL) and less operative time than the SMP group (P<0.0001).  While the time for starting weight bearing was considerably earlier in the SMPs group (P<0.005).
Conclusion Both FNs and SMPs can be used for fixation diaphyseal femoral shaft fractures; FNs offer shorter operating times and lower EBL, whereas SMPs require less time for weight bearing and union.