الفهرس 
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Abstract
This prospective study was conducted on 40 school aged children with subtrochanteric femur fracture grouped according to the method of their management into group A which were treated by fluoroscopic guided reduction and fixation by TENs and group B which were treated by open reduction and internal fixation by plates and screws in Minia University Hospital from January 2018 to January 2020.
Informed consent was obtained from at least one of the parents following our local medical ethical committee rules.
Patients were followed up regularly at 2 weeks interval in the first two months, then monthly till 6 months postoperative and at the end of the study respectively to evaluate the results clinically, radiologically, functional outcome and complications.
The data collected from patients was analyzed, evaluated, and the observations were recorded. The aim was to compare radiological and clinical outcome of TENs and plate fixation in subtrochanteric femur fractures in school-age children, and to analyze any possible complications.
All the patients were examined clinically and radiological, including detail history of trauma, through general and local examination including neurovascular status of the limb and any associated injuries or co morbidities at the time of admission. Patients fulfilling the inclusion criteria were only included in the study.
The study included 40 patients ( 26 males , 14 females ) . Mean age was (6.78±2.007) ranging from 4.4 to 14 years . There were male predominance ( 65%).
Spiral fractures were the most encountered fracture pattern in 13 cases (32.5%), transverse fractures in 11 cases (27.5%), oblique fractures in 9 cases (21.5%) and 7 cases has wedge fractures . Length stable fractures were recorded in 50% of cases and the other half were length unstable fracture patterns.
Subtrochanteric fracture was defined as fracture below lesser trochanter by 10% of all femur length. Average femur length was 33.3 cm ranging from 26.1 to 46.1. Average distance below lesser trochanter was 2.11 cm ranging from 08 to 3.5 cm
Preoperatively children were weighed. average weight was 27.2± 9.23 kg in group A and 24.85± 4.59 kg in group B. Associated injuries were found in eight patients (20%), five of them was associated with head injuries, tibial fractures in two cases, one case with radius fracture.
There was not any statistically difference between two groups regarding age, sex, weight, side, mechanism of trauma or follow duration, however there was statistically difference regarding operative time, intraoperative blood loss, hospital stay after surgery and using of postoperative immobilization.
All cases were followed up for 46.575 weeks ranging from 28 to 76 weeks. clinical and radiographical examination was done in each of follow up visits. Radiographic union, callus seen at least three cortices, was noticed to be earlier in group A cases (9.9+ 1.25 weeks) than in group B cases (11.825+ 0.988).
All the patients in the two groups walks freely of pain or limitations. Overall complication rate in group A (45%) was higher than in group B (30%). group A cases suffered twelve complication in nine cases, most common was leg length discrepancy in four cases, malalignment in four cases, then pain from irritation at insertion site in three cases and one child had flexion deformity about 20 degree was referred to physiotherapy and did not show in his last appointments of his follow up. In group B three cases had leg length discrepancy, only two cases had malalignment and one child had superficial infection that resolved after one week of intravenous antibiotic given according to culture and sensitivity. None of the patient needed reoperation due to major complications.