Thesis (Ph.D)-Cairo University, 2025.

Bibliography: pages128-140.

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.

Issues also as CD.

Text in English and abstract in Arabic & English.