Vol. 11, Issue 1 (2025)

Background: Femoral diaphysis fractures provide a risk of morbidity in paediatric patients. Numerous fixation techniques have been devised, although there exists only little data to support their usage. This systematic study aimed to evaluate the clinical results of flexible intramedullary nailing with plate and screws in treating femoral diaphyseal fractures in children aged 5 to 10 years.
Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines when performing our study as we searched PubMed, Scopus and Web of Science databases from inception to February 2023 for eligible articles to be included in our study. Criteria for inclusion had been articles comparing the elastic intramedullary nailing technique with the plate and screws technique in children. We involved all types of observational studies (cohort, case-control, and cross-sectional) in addition to randomized controlled trials. The RoB 2 tools assessed the risk of bias.
Results: A total of 268 articles were identified, with 14 studies meeting the eligibility criteria. Quality assessment revealed that four RCTs had low risk of bias, while three had high risk, and one had some concerns. Among observational studies, three were of high quality, and two were of moderate quality. Intramedullary nailing was associated with significantly decreased operation time, lower blood loss, and shorter hospital stay compared to the plate and screws technique (p < 0.05 for all). Additionally, the intramedullary technique demonstrated faster healing time (p = 0.001). However, no significant differences were found between the two techniques in terms of limb length discrepancy (p = 0.66) or Flynn score (p = 0.75). Intramedullary nailing was linked to a higher incidence of complications, with an odds ratio of 3.09 (p = 0.03).
Conclusions: The usage of intramedullary nails in treating of femoral diaphyseal fractures in children from 5 to 10 years old is associated with better outcomes regarding operation time, blood loss, healing time and hospital stay while it is associated with more incidence of complications such as ankylosis and angular deformity compared to plate and screws. There was no difference between the two techniques regarding Flynn score, and limb length discrepancy.