Treatment of paediatric subtrochanteric femoral fractures using titanium elastic nails: a single-center experience.

BACKGROUND: Subtrochanteric femoral fractures in children are uncommon but challenging to manage due to high mechanical stresses and their proximity to the growth plate. While the Titanium Elastic Nailing System (TENS) has proven effective for paediatric diaphyseal fractures, its role in subtrochanteric fractures is less well established. AIM: The aim of this study was to evaluate the clinical and radiological outcomes of paediatric subtrochanteric femoral fractures treated with TENS, specifically assessing union rates, complications, and functional outcomes using Flynn's criteria. METHODS: We conducted a prospective observational study of 18 children aged 5-11 years with radiologicaly confirmed subtrochanteric femoral fractures treated using TENS at a tertiary care centre. Patient demographics, fracture patterns, associated injuries, time to surgery, postoperative immobilization, time to weight bearing, fracture union, complications, and outcomes were recorded and analysed. RESULTS: The mean age of patients was 7.7 years, with a male predominance (61%). The most common fracture patterns were oblique and spiral. Associated injuries were seen in 4 patients, and the average time to surgery was 2.1 days. Partial weight bearing was initiated by 4-5 weeks, and radiological union was achieved in all patients, with a mean union time of 9.5 weeks. Complications included limb length discrepancy (1 case), nail irritation (2 cases), and delayed union or malalignment (2 cases). According to Flynn's criteria, 72% had excellent, 22% good, and 6% satisfactory outcomes. CONCLUSION: TENS is a safe, minimally invasive, and effective treatment for paediatric subtrochanteric femoral fractures in children aged 5-11 years. When applied with proper technique and patient selection, it results in reliable union, early mobilization, and favourable functional outcomes with minimal complications.