Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Orthopaedic Surgery

Background :Pediatric femoral shaft fractures are common orthopaedic injuries. Although many approaches and options are available for their treatment ,the most appropriate treatment option for school going children is still debatable.This study investigated the radiological and functional outcome of surgical intervention with Nancy nails in 3-8 year old children with diaphyseal femoral fractures and compared them with those of conservative management.Patients and Methods Between March 2020 and December 2020, a prospective randomized controlled study was conducted on 26 patients with unilateral pediatric femoral shaft fractures. The subjects were divided into 2 groups; a group managed with Nancy nails, the other was treated conservatively. In the Nancy group there was 13patients, with a mean age of 5.15 years . In the conservative group we treated 13 patients. Their mean age was 3.69 years.In the Nancy group, Nancy nails were introduced in a retrograde fashion. Nail size was chosen that both nails occupied 80% of the narrowest canal diameter (NCD). For patients treated conservatively, skin traction was applied for 2-3 weeks. Weekly follow-up x-rays were done waiting for soft callus, then the patient was put in one and half hip spica for mean of 5.6 weeks.Results Our 26 patients were followed-up and assessed for a mean of 6 months; 13 in each group. At the last follow-up, patients in the operative group were 13 (100%) excellent according to Flynn{u2019}s scoring criteria. In the conservative group, 9(69.2%) were excellent, 4(30.8%) were satisfactory. We found no statistically significant difference between both groups regarding deformities (p-value 0.096) , knee range of motion at 6 months follow-up (p-values 0.005), and total Flynn{u2019}s score (p-value 0.096). There was no statistically significant difference between both groups; regarding age (p-value 0.005). time to union (p-value 0.149).and LLD (p-0.096)

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