COMPARATIVE STUDY BETWEEN (MIPO)SUBMUSCULAR PLATE FIXATION OF FRACTURE FEMUR AND CONSERVATIVE MANAGEMENT WITH THOMAS SPLINT IN CHILDREN FROM 5 TO 8 YEARS OLD: A RANDOMIZED CLINICAL STUDY

Abstract

Introduction: Pediatric femoral shaft fractures are common injuries that can substantially affect a child's growth and development. The ideal treatment strategy for femoral fractures in children aged 5 to 8 years continues to be a subject of debate. This study aims to compare the results of submuscular Minimally Invasive Plate Osteosynthesis (MIPO) with conservative management involving traction with the Thomas splint followed by casting in this age group.

Methods: A multicenter randomized controlled trial was performed with 75 children aged 5 to 8 years who had femoral shaft fractures. Patients were randomly allocated to either the submuscular MIPO group or the conservative management group. The outcomes assessed were the duration until radiographic union occurred as well as the rate of complications.

Results: Radiographic union occurred more rapidly in the submuscular MIPO group. The MIPO group exhibited a reduced complication rate, reporting merely two instances of superficial wound infection. In contrast, the Thomas splint group encountered several complications, including malunion and limb length discrepancy, with four cases necessitating surgical intervention.

Conclusion: Submuscular MIPO provides considerable benefits compared to conservative management for femoral fractures in children aged 5 to 8 years. The earlier weight-bearing capacity, faster radiographic union and reduced complication rates render submuscular MIPO the treatment of choice for this demographic. Nonetheless, conservative management is a feasible option in environments with restricted surgical resources.

Key Words: Pediatric femoral fracture, Conservative, Thomas splint, Traction, Surgical intervention, MIPO

Level of Evidence: Level II, Randomized Controlled Trial.