Orthopaedic Trauma Pediatric Orthopaedics
PURPOSE: To investigate whether radiographic technical parameters reflecting pre-bend appropriateness are associated with radiographic and clinical outcomes after titanium elastic nailing (TEN) in pediatric femoral mid-shaft fractures.
METHODS: This retrospective cohort included 85 children aged 5-11 years treated with TEN between 2015 and 2025. Constructs were classified as criteria-met (n = 38) or criteria-unmet (n = 47) using nail symmetry, a bend apex-fracture apex distance ratio ≤ 10%, and a metaphyseal spread ratio ≥ 50%. Separate exploratory multivariable models evaluated the composite classification and its components, adjusting for clinical and technical covariates.
RESULTS: Median coronal angulation was lower in the criteria-met group (2.0° vs 5.0°; p = 0.005). The adjusted mean difference (criteria-unmet minus criteria-met) was 3.42° (95% CI 0.98-5.87; p = 0.007). Other group comparisons were inconclusive. Exploratory component analysis associated greater spread with greater limb length discrepancy (3.61 mm per increase of 10 %age points; 95% CI 1.81-5.40; q = 0.002), although technical parameters were highly correlated. The complication risk ratio for criteria-unmet versus criteria-met constructs was 1.41 (95% CI 0.45-4.48).
CONCLUSION: Meeting the study-specific radiographic criteria was associated with lower coronal angulation, but its clinical importance remains uncertain. Overlapping criteria, correlated technical parameters, and limited precision preclude conclusions of equivalence or definitive independent effects.
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