Functional Outcome of Femoral Fracture in Children Treated with Titanium Elastic Nailing System (TENS): A Prospective Study in Sana'a, Yemen

Abstract

Introduction: This study aimed to evaluate the functional outcomes of pediatric femoral shaft fractures treated with a Titanium Elastic Nailing System (TENS) in two tertiary hospitals in Sana'a, Yemen, between 2021 and 2023. The primary objective of this study was to assess the efficacy and safety of TENS for achieving bone union, restoring limb function, and minimizing complications in a resource-limited setting.

Materials and methods: This prospective observational study was conducted at Al-Thawra Modern General Hospital and Al-Kuwait University Hospital, Sana'a, Yemen. Twenty children aged six–13 years with closed unilateral femoral shaft fractures were treated using TENS. Functional outcomes were assessed using Flynn's criteria, which evaluates alignment, leg length discrepancy, and perioperative complications. Follow-up visits were conducted four, eight, 12, and six months postoperatively.

Results: The mean age of the participants was 9.06 ± 1.9 years, with 14 males (70%) and six females (30%). Road traffic accidents were the most common cause of injury (10 cases, 50%). Excellent functional outcomes were observed in 15 cases (75%), and satisfactory outcomes in five cases (25%). Complications were minimal, with pain at the nail insertion site reported in three patients (15%), limb length discrepancy in one patient (5%), and malalignment in one patient (5%). No major complications such as nonunion or infection were observed.

Conclusion: TENS is a safe and effective treatment for pediatric femoral shaft fractures with high rates of excellent functional outcomes and minimal complications. These findings support the use of TENS as a first-line treatment in resource-limited settings, offering a practical alternative to traditional methods, such as spica casting. Future research should focus on larger multicenter studies to validate our findings and explore the long-term outcomes.