Objective To compare the therapeutic effect of elastic intramedullary nail fixation versus external fixator(Orthofix) for closed transverse or short oblique middle femoral shaft fractures in children. Methods Between March

2009 and August

2018

67 children with closed transverse or short oblique middle femoral shaft fractures were treated with elastic intramedullary nail fixation(ESIN group

34 cases) or external fixation(EF group

33 cases). The operation time

intraoperative bleeding volume

fracture healing time

postoperative knee joint functions and postoperative complications were compared between the two groups. Results The EF group and ESIN group showed no significant difference in the operation time(110.67±54.04 vs 87.73±23.42 min

P<0.05)

intraoperative bleeding volume(152.82±192.01 vs 48.35±48.78 mL

P<0.05)

or fracture healing time(10.83±4.22 vs 10.01±5.02 weeks

P>0.05). The rate of good postoperative knee joint function was significantly higher in ESIN group than in EF group(78.79% vs 97.06%

P<0.05). The incidences of wound infections and refracture of the femoral shaft were significantly lower in ESIN group than in EF group(χ~2=10.52

P<0.05; χ~2=5.57

P<0.05

respectively)

but the incidence of delayed union did not differ significantly between the two groups. Conclusion Compared with external fixation

elastic intramedullary nail fixation achieves better clinical outcomes with reduced postoperative complications

and is therefore recommended as the primary treatment option for closed transverse or short oblique middle femoral shaft fractures in children.