TY  - BOOK
AU  - Mohamed Nasser Ibrahim Elkholy,
AU  - Ahmed Nabawy Morrah
AU  - Amr Saeed Arafa
AU  - Ahmed Samir Farahat
TI  - Flexible intramedullary nails with supplemental external fixator versus biological plate fixation in treating length unstable pediatric femur fractures
U1  - 617.158 
PY  - 2025///
KW  - Femur fractures
KW  - كسور عظمة الفخذ
KW  - Pediatric femur fracture
KW  - Submuscular plating
KW  - Flexible nailing
KW  - External fixator
KW  - Unstable fractures
KW  - المسمار النخاعي المرن المدعم
KW  - بمثبت خارجي والشرائح البيولوجية لعظمة الفخذ في الأطفال
N1  - Thesis (Ph.D)-Cairo University, 2025; Bibliography: pages128-140.; Issues also as CD
N2  - Background: The optimal surgical management of length-unstable pediatric femoral 
shaft fractures remains debated. This study compares the clinical and radiological 
outcomes of submuscular biological plating (SBP) versus flexible intramedullary 
nailing augmented with external fixation (FIMN/EF) for these fractures. 

Methods: A prospective randomized trial included 32 children (5–14 years) with 
unstable femoral fractures (AO/OTA 32-D/5.1 and 32-D/5.2). Patients were divided into 
SBP (n=16) and FIMN/EF (n=16) groups. Outcomes assessed included operative 
parameters, union time, complications, limb alignment, and functional recovery using 
Flynn’s criteria. 

Results: Submuscular biological plating demonstrated significantly shorter operative 
time (73.1±14.1 vs. 88.8±11.0 minutes, p=0.002) and fluoroscopy time (51.9±12.3 vs. 
74.1±16.0 seconds, p<0.001). Both groups achieved similar union times (10.5 vs. 10.7 
weeks) and full weight-bearing (8.5 vs. 8.7 weeks). Submuscular biological plating 
showed superior early knee range of motion (108.1° vs. 100.6° at 1 week, p=0.015), but 
differences diminished by 3 months. Coronal plane angulation was lower in SBP (1.1° 
vs. 2.8°, p=0.015). Infection rates (12.5% vs. 18.8%) and limb length discrepancies 
(≤10 mm) were comparable. Functional outcomes (Flynn’s criteria) were excellent in 
87.5% (SBP) and 81.3% (FIMN/EF), with no significant difference (p=0.361). Implant 
removal was faster and less invasive in FIMN/EF (p<0.001). 

Conclusion: Both techniques effectively manage unstable pediatric femoral fractures. 
Submuscular biological plating offers intraoperative efficiency and early mobility, while 
FIMN/EF allows immediate weight-bearing and simpler implant removal. Choice 
depends on fracture location, surgeon expertise, and socioeconomic factors. This study 
supports biologic fixation principles, emphasizing minimal soft-tissue disruption and 
early functional recovery in pediatric orthopedics.; لذا الهدف من هذه الدراسة هو تقييم ومقارنة النتائجالإكلينيكية ونتائج الأشعة للكسور غير المستقرة في الأطفال بعد إصلاحها بواسطة الشرائح المعدنية البيولوجية تحت العضلات او المسامير النخاعية المرنة المعززة بمثبت خارجي.وقد تمت الدراسة على اثنينوثلاثين طفلا يعانون من كسور غير مستقرة الطول بعظمة الفخذ.
وقد أظهرت النتائج انلكلتا الطريقتين نتائج مرضية مع معدل ممتازة لالتئام الكسور مع محاذاة مقبولة، ومدى جيد للحركة بعد الجراحة، واستعادة المشية الطبيعيةومعدلات منخفضة جدا تكاد تكون نادرة لحدوث المضاعفات في علاج كسور عظم الفخذ غير المستقرة الطول عند الأطفال
ER  -