Peer-reviewed article

Early Mobilization with Mechanical Axis Preservation: A Prospective Outcome Analysis of Titanium Elastic Nailing in Femoral Shaft Fractures of School-Aged Children.

Singh S, Yadav A, Lal AK, Mishra A, Tripathi A et al. · 1 Jul 2026

Abstract

Introduction Pediatric femoral shaft fractures are one of the commonest injuries in early childhood and school-going children, with operative management increasing preferred in the age group of 6-13 years. The titanium elastic nailing system (TENS) is the most preferred modality in this age group, providing stable fixation and biological preservation; however, its effect on mechanical axis alignment and early functional outcome needs evaluation. In this study, we aim to analyze the effect of femur shaft fractures being managed by TENS on the mechanical axis of the lower limb and its effect on the functional outcome of the patients after a short immobilization period of 2 weeks. Materials and methods A prospective observational study was conducted at Baba Raghav Das Medical College, Gorakhpur between 2023 and 2025, including 32 children aged 6-13 years with femoral diaphyseal fracture undergoing TENS (excluding Gustillo-Anderson type IIIB/IIIC Injuries). Regular follow-up was done at 2, 6, and 12 weeks, and functional and radiological outcomes and mechanical alignment were recorded at 12 weeks using Flynn scoring criteria and orthoscanogram, respectively. Results Our study group had a mean age of 9.66 ± 2.25 years, with a higher male predilection (71.9%) and road traffic accident (43.8%) being the common mode of injury. We observed radiological union in all the patients with a mean union time of 10.88 ± 0.9 weeks, with no significant malalignment with mean medial proximal tibial angle and lateral distal femoral angle within an acceptable range, even after a short immobilization period. We observed a mean knee flexion of 112.7° ± 13.7° at 12 weeks follow-up, with 81.2% of patients having excellent and the remaining 18.8% having satisfactory outcome with no poor results. Conclusion TENS is a safe, minimally invasive, alignment-preserving modality which provides stable fixation, excellent short-term outcomes with minimal complications in 6-13 years age group, irrespective of age, gender, or fracture type.