Comparing the Outcomes of Titanium and Stainless Steel Flexible Nails in Repairing Pediatric Long Bone Fractures

Background Traditionally, pediatric femoral fracture treatment favored conservative methods, relying on casting and the inherent bone remodeling ability in immature bones. Surgical intervention was deferred until age 6, as nonoperative approaches often resulted in complications. Titanium elastic nailing (TENS) emerged as an effective treatment for diaphyseal femoral fractures in ages 6 to 16. However, the choice between TENS and stainless steel elastic nailing (SSENS) remains debated due to inconsistent findings. Objective This study aimed to evaluate the effectiveness of both nailing systems in pediatric long bone fractures. Methods A retrospective chart review at William Beaumont Hospital Royal Oak included 83 patients aged 6 to 16 treated with TENS or SSENS between January 2011 and January 2021. Data collected encompassed nail related issues, time to fracture union, full weight bearing, and nail removal. Results In the TENS group (n=29), the average age was 8.8 +/- 2.4 years, and the average BMI was 17.2 +/- 3.4. The SSENS group (n=54) had an average age of 9.3 +/- 2.7 and an average BMI of 19.7 +/- 8.4. Time to fracture union for TENS was 93.8 +/- 60.5 days, while SSENS was 82.2 +/- 40.0 days. Conclusion This study found no statistically significant differences in nail-related complications, time to fracture union, full weight bearing, or nail removal between TENS and SSENS in pediatric long bone fractures. The choice between these systems should be based on individual circumstances. Limitations include a small sample size and the study's retrospective nature.