Displaced Tibia Fractures in Adolescents: Closed Reduction and Casting Versus Flexible Intramedullary Nails

Rivera, Asdrubal E; Cummings, Jason L.; Pereira, Daniel E.; Oladeji, Afolayan K; Landau, Andrew J; Hosseinzadeh, Pooya

doi:10.1097/bpo.0000000000002273

Cited by 6 publications

(12 citation statements)

References 37 publications

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“…While ESIN is becoming a more popular technique with excellent results, complications such as postoperative compartment syndrome, malunion, delayed union, and nonunion have been identified as potential risks of ESIN treatment of pediatric diaphyseal tibial fractures. 3,[5][6][7][8][9][10][11][12][13][14][15] In our series, compartment syndrome occurred in only 4.1% of patients, well below the published rates (8% to 32%). 8,10,16 Open fractures have an increased risk of healing complications, delayed union, nonunion, and residual angular deformity.…”

Section: Discussioncontrasting

confidence: 71%

Outcomes of Elastic Stable Intramedullary Nailing for Surgical Treatment of Pediatric Tibial Shaft Fractures

Landau,

Oladeji,

Cummings

et al. 2023

JAAOS Glob Res Rev

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Background: This retrospective study aimed to assess radiographic and clinical outcomes, characterize demographic, injury, and fracture characteristics, and elucidate the rate of postoperative complications and associated factors in a large cohort of children treated with elastic stable intramedullary nail for diaphyseal tibial fractures at two large pediatric referral centers. Methods: Medical records were reviewed for demographic clinical and radiographic parameters at injury, surgery, and all subsequent clinical visits until radiographic healing was observed and/or for a minimum of 6 months postoperatively. Results: A total of 146 patients (79.5% male) were included. The mean (SD) age was 11.8 (63.0) years. Radiographic union occurred by 3 months in 56.6% of patients. Nine patients had delayed union, and four had nonunion. By 3 months postoperatively, 97.2% of patients had progressed to full weight bearing and 92.5% had full range of motion of the knee and ankle. Subgroup analyses revealed that patients with open fractures were found to be more than eight times at increased risk of developing delayed union (.6 months, odds ratio = 8.71). Conclusion: Elastic stable intramedullary nail remains a safe and effective treatment of open and closed pediatric diaphyseal tibial fractures. A small yet notable risk of residual angular deformity, delayed union, and nonunion remains, although rates may be better than previously reported.

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Section: Discussioncontrasting

confidence: 71%

Outcomes of Elastic Stable Intramedullary Nailing for Surgical Treatment of Pediatric Tibial Shaft Fractures

Landau,

Oladeji,

Cummings

et al. 2023

JAAOS Glob Res Rev

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“…Previous research on nonoperative treatment for tibial shaft fractures in adolescents demonstrated only a highly variable rate of unplanned surgery-ranging from 4% in Ho et al's study to 40% in Kinney et al's study. 10,11,13 Our comprehensive definition of complications likely contributed to our complication rate being just higher than the rate in Kinney et al's 13 study. While we discuss complications as a single variable, we acknowledge that different complications have unique risk factors.…”

Section: Discussionmentioning

confidence: 73%

“…5 While surgery may be necessary in a subset of adolescents, previous research has suggested that outcomes after cast treatment alone are often favorable with minimal complications. 10,11 This is the largest study to date looking at outcomes after both operative and nonoperative tibial shaft fractures in adolescents.…”

Section: Discussionmentioning

confidence: 99%

Not Just Small Adults: Operative Versus Nonoperative Treatment in Adolescent Tibial Shaft Fractures

Kiani,

Badrinath,

Baldwin

2024

Journal of Pediatric Orthopaedics

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Background: The standard of care for tibial shaft fractures in young children is nonoperative management, while in adults, operative treatment is considered the mainstay. There are no clear guidelines on preferred treatment for adolescents. Purpose: This paper aims to 1) identify clinical and radiographic characteristics predictive of malalignment and 2) determine if treatment type affects malalignment risk. Methods: This retrospective cohort study identified patients aged 12 to 16 years old with a tibial shaft fracture at a Level 1 pediatric trauma center. The primary outcome of interest was malalignment, classified as meeting one or more of the following: >5° coronal angulation, >5° sagittal angulation, translation (cortical width or 100% displaced), and/or rotational deformity. Comparative analyses were done to identify risk factors for malalignment. Results: A total of 162 patients were included—initial treatment was “planned nonoperative” for 102 patients and “planned operative” for 60 patients. The malalignment rate was 34% in the planned nonoperative group versus 32% in the planned operative group. In a multivariate regression, older patients [odds ratio (OR)=−0.07, 95% CI: −0.13 to −0.01; P=0.024] and those with 100% initial displacement (OR=−0.35, 95% CI: −0.64 to −0.05; P=0.021) had decreased odds of malalignment, and having increased sagittal angulation (OR=0.02, 95% CI: 0.01-0.04; P=0.002) and a fibula fracture (OR=0.22, 95% CI: 0.03-0.41; P=0.023) increased the odds of malalignment. There was no difference in the rate of malalignment by initial treatment (P=0.289). Having a planned nonoperative treatment (OR=22.7, 95% CI: 14.0-31.5; P<0.001) and having a fibula fracture (OR=8.52, 95% CI: 0.59-16.45; P=0.035) increased the time immobilized. Conclusions: This study provides insight into factors affecting tibial shaft fracture alignment among patients aged 12 to 16 years. This study suggests that the risk of malalignment is higher among patients with increased initial sagittal angulation and concomitant fibula fractures, but the risk of malalignment is comparable in patients initially treated nonoperatively and operatively. Although healing parameters on average were similar, nonoperative treatment results in longer immobilization time and time for unrestricted weight bearing. Level of Evidence: Level III—retrospective comparative study.

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“…A predictive score was developed to accurately determine infantile Blount disease recurrence after tibial osteotomy and comprises age of <42 months, LaMont classification type C, and medial metaphyseal beak angle of >128°1 9 . Another study of multiple types of coronal plane deformity evaluated the rate of correction for transphyseal screws and growth modulation plates from the time of the surgical procedure to the first postoperative radiograph.…”

Section: Limb Deformity and Reconstructionmentioning

confidence: 99%

What’s New in Pediatric Orthopaedics

Hardesty

2023

Journal of Bone and Joint Surgery

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InfectionPediatric acute hematogenous osteomyelitis can cause severe illness in children, and a study from New Zealand found that the development of acute (early) complications was more likely to occur if the C-reactive protein (CRP) failed to reduce by 50% at days 4 and 5 after the initiation of treatment 12 . Furthermore, Disclosure: The Disclosure of Potential Conflicts of Interest form is provided with the online version of the article (http://links.lww.com/JBJS/H805).

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Displaced Tibia Fractures in Adolescents: Closed Reduction and Casting Versus Flexible Intramedullary Nails

Abstract: Bold values are statistically significant. CRC indicates closed reduction and casting; ESIN, elastic stable intramedullary nail; N, frequency; N%, divided by total in each group (ESIN = 72; CRC = 69); OR, operating room.

Cited by 6 publications

References 37 publications

Outcomes of Elastic Stable Intramedullary Nailing for Surgical Treatment of Pediatric Tibial Shaft Fractures

Outcomes of Elastic Stable Intramedullary Nailing for Surgical Treatment of Pediatric Tibial Shaft Fractures

Not Just Small Adults: Operative Versus Nonoperative Treatment in Adolescent Tibial Shaft Fractures

What’s New in Pediatric Orthopaedics

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