PubMed^® Literature Review

Comparisons between traction and spica casting versus ESIN have not demonstrated significant differences in clinical and functional outcomes. However, the elastic nailing approach is associated with a markedly reduced duration of inpatient hospital admission and a lower overall cost. In the case of a femoral shaft fracture in a 2-year-old, the literature does not provide clear superiority of one technique over another for this specific age group. Nonetheless, the beneficial aspects of ESIN, such as cost-effectiveness and overall strong efficacy for indicated age and weight groups, suggest potential advantages. Two large studies support using elastic stable intramedullary nailing (ESIN) for femur fractures in patients as young as two [1][3][4]. A 2010-2020 study analyzed 30 patients (average age 2.1 ± 0.7 years) treated with ESIN. The average time-to-surgery was 4.6 hours, with signs of fracture consolidation in 2/3 of patients after 3.4 weeks [3]. Full mobility was achieved in about 5.6 weeks without ESIN-related complications or non-union [3]. A 2019 retrospective study on 2-15 year olds with unstable femoral fractures found similar recovery timelines [4]. Yet, the 5.1 months average follow-up time in the first study and lack of control groups in both studies limits the strength of the evidence [3]. The orthopedic field debates optimal treatment for young patients. Some studies suggest surgical fixation for younger patients [5][8]. However, a comparison between ESIN and spica casting found no significant difference in outcomes despite age differences [6]. An age-based and evidence-based algorithm emphasizes patient-specific treatment considerations [2]. While ESIN is promising for treating femur fractures in young patients, more randomized control trials and long-term follow-up studies are needed to evaluate its efficacy and potential complications.

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