Titanium elastic nailing for noncomminuted femoral fractures in older adolescents and young adults: a prospective comparative study versus interlocking nailing

There are no reports of using titanium elastic nail (TEN) over 18 years. This article studies using TEN in young adults and tries to define its usefulness and safety compared to the standard treatment with interlocking nailing (IN).

A prospective comparative study.

This study was conducted in a level-1 trauma center.

Thirty-one fractures in 30 patients with a mean age of 19.1 (17–21) years were treated with TEN compared to 32 fractures in 31 patients with a mean age of 19.0 (17–21) treated with IN with 2 years minimum follow-up.

Outcomes included union, malunion, return of activities, hospital stay, operative time, postoperative pain, radiation, and cost.

IN was biologically better (with no statistical significance) than TEN: union (11.7 ± .2.4 versus 10.8 ± 2.1 weeks), coronal angular deformity (CAD) (1.2 ± 1.7° versus 0.4 ± 1.3°), shortening (0.9 ± 1.3 mm versus 0.4 ± 1.2 mm), sagittal angular deformity (SAD) (0.9 ± 1.4° versus 0.5 ± 1.6°), or rotational deformity (RD) (1.3 ± 1.2° versus 0.5 ± 1.4°). IN was functionally better: earlier full weight-bearing (2.9 ± 1.9 versus 11.7 ± .2.1 weeks, P = .000) and earlier return of activity (15.9 ± 2.4 versus 17.3 ± 2.8 weeks, P = .003). TEN had shorter operative time (54.8 ± .9 versus 62.5.0 ± 16.0 min with P = .024), postoperative pain (P = .001), and cost by 22.6 % (P = .001). Four of TEN group had painful nail end, and two had calcar penetration. Heterotopic ossifications occurred in four cases (IN). Mean follow-up was 29.6 months (TEN) and 30.1 (IN). We had no length discrepancy, nonunion, refractures, infection, or deaths.

TEN is inferior to IN functionally, close to it biologically, superior to it as to cost, postoperative pain, and surgical time, and can be considered a safe option in this age group.

Therapeutic level II.