Background: The operative treatment of femoral shaft fractures in children of 6- to 12-year-old necessitates the controversial operative options of elastic stable intramedullary nailing (ESIN) and dynamic compression plating (DCP).

Objective: To compare clinical outcomes of the operative options between the ESIN and the DCP for treatment of pediatric femoral shaft fractures.

Material and Method: Analyzes of femoral shaft fractures were conducted among the pediatric patients of the Khon Kaen Hospital, 6- to 12-year-old, treated with either ESIN or DCP techniques between January 2012 and December 2015. Medical records and radiographs were retrospectively reviewed for recorded data; regarding demographics, union time, operative time, estimated blood loss, and complications.

Results: Fifty-four consecutive patients with 55 femoral shaft fractures were evaluated, in which 21 femoral fractures treated with ESIN fixation, and 34 with DCP fixation with comparable demographic data. There was a statistically significant difference between the ESIN and DCP groups in estimated blood loss (5.4±2.1 and 68.8±23.1 ml, p<0.001), but no statistically significant differences of union time (8.8±1.5 and 12.2±6.9 weeks, p = 0.077), operative time (101.9±9.9 and 52.1±7.1 minutes, p = 0.141), numbers of complication events (14.3 and 17.6%, p = 0.743), and numbers of malunion (19.0 and 8.8%, p = 0.269). The most common complication with ESIN was pin tract infection (three events), and peri-implant or mechanical related failure (six events) with DCP.

Conclusion: ESIN fixation for pediatric femoral shaft fractures presented significantly less intraoperative blood loss than the DCP fixation, but no significant differences in union time, operative time, and numbers of complication and malunion.

Keywords: Pediatric femoral shaft fracture, Elastic stable intramedullary nailing, Dynamic compression plating