Elastic intramedullary nailing in unstable fractures of the paediatric tibial diaphysis: A systematic review

Swindells, Mark G.; Rajan, Roy

doi:10.1007/s11832-009-0223-4

Cited by 18 publications

(6 citation statements)

References 20 publications

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“…Titanium elastic nails (TENs) have recently emerged as a popular treatment option in select open fractures due to several advantages including applicability in open fractures, minimal scar formation, and providing excellent outcomes in pediatric tibial shaft fractures [14,15].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails

Uludağ

Tosun

2019

Medicina

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Background and objectives: Pediatric tibial shaft fractures often have satisfactory outcomes after closed reduction and casting. However, surgical treatment may be required in unstable or open fractures. Titanium elastic nails (TENs) are a good option for the surgical treatment of pediatric tibial fractures due to their advantages such as short hospitalization periods, easy applicability, early weight bearing, and early union. In this study, we evaluated radiological and functional outcomes in pediatric patients with tibial shaft fractures that underwent fixation with TENs. Materials and methods: A total of twenty tibial shaft fractures that were treated with TENs in our clinic between 2013 and 2017 were retrospectively reviewed. The mean age at injury was 8.9 ± 2.78 (range of 3–14) years. Seven (35%) out of 20 fractures were open fractures, of which one fracture was classified as Grade I and six fractures were classified as Grade II. In each patient, antegrade nailing was performed by inserting a TEN in the medial and another TEN in the lateral side of the proximal metaphysis. Clinical outcomes including union, alignment, leg-length inequality, and complications were evaluated using modified Flynn’s criteria. Results: The mean time to union was 10.85 ± 3.39 (range of 6–20) weeks. No patient had a sagittal or coronal angulation of over 10°. One patient had a leg-length inequality of 10 mm. Among three patients with open fractures, two of them had superficial wound infections and the other patient had a deep wound infection. All the infections were successfully treated with appropriate antibiotic therapies. Four other patients had pin tract irritation that required no intervention. No significant difference was observed between patients with open and closed fractures with regard to the clinical and radiological findings although patients with open fractures had a significantly higher complication rate compared to patients with closed fractures (p < 0.05). No patient had a restricted range of motion of the ankle and knee joints. Twelve (60%) patients had an excellent outcome, and eight (40%) patients had a satisfactory outcome. Conclusions: Intramedullary fixation with TENs provides favorable outcomes and reduced complication rates in the treatment of unstable pediatric tibial shaft fractures that cannot be reduced with conservative treatment modalities or cannot be casted due to the presence of an edema or open wound.

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Section: Discussionmentioning

confidence: 99%

Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails

Uludağ

Tosun

2019

Medicina

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“…Tibial fractures are common in ambulatory children [1]. Many different methods of fixation have been used, each with varying degrees of success [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Management of paediatric tibial fractures using two types of circular external fixator: Taylor spatial frame and Ilizarov circular fixator

Tafazal

Madan

Ali

et al. 2014

Journal of Children's Orthopaedics

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BackgroundThe use of circular fixators for the treatment of tibial fractures is well established in the literature. The aim of this study was to compare the Ilizarov circular fixator (ICF) with the Taylor spatial frame (TSF) in terms of treatment results in consecutive patients with tibial fractures that required operative management.MethodA retrospective analysis of patient records and radiographs was performed to obtain patient data, information on injury sustained, the operative technique used, time duration in frame, healing time and complications of treatment. The minimum follow-up was 24 months.ResultsTen patients were treated with ICF between 2000 and 2005, while 15 patients have been treated with TSF since 2005. Two of the 10 treated with ICF and 5 of the 15 treated with TSF were open fractures. All patients went on to achieve complete union. Mean duration in the frame was 12.7 weeks for ICF and 14.8 weeks for the TSF group. Two patients in the TSF group had delayed union and required additional procedures including adjustment of fixator and bone grafting. There was one malunion in the TSF group that required osteotomy and reapplication of frame. There were seven and nine pin-site infections in the ICF and TSF groups, respectively, all of which responded to antibiotics. There were no refractures in either group.ConclusionIn an appropriate patient, both types of circular fixator are equally effective but have different characteristics, with TSF allowing for postoperative deformity correction. Of concern are the two cases of delayed union in the TSF group, all in patients with high-energy injuries. We feel another larger study is required to provide further clarity in this matter.Level of evidenceLevel II—comparative study.

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“…Swindells and Rajan performed a systematic review of seven different retrospective studies regarding tibial ESIN with outcomes of 210 patients [ 29 ]. The authors of those studies described several indications for use of ESIN in pediatric patients, but most of them stated that the main indication was unstable fractures.…”

Section: Discussionmentioning

confidence: 99%

Elastic Stable Intramedullary Nailing for Treatment of Pediatric Tibial Fractures: A 20-Year Single Center Experience of 132 Cases

Pogorelić

Vegan²,

Jukić³

et al. 2022

Children

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Objective: The aim of this study was to analyze the outcomes and complications in children treated with elastic stable intramedullary nailing (ESIN) for tibial fractures. Methods: The study included 132 patients (92 males) with a median age of 11 years (IQR 10, 15) treated with ESIN for displaced tibial shaft fractures or dia-metaphyseal distal tibial fractures from March 2002 to March 2022. The median follow-up was 118.5 months (IQR 74.5, 170). The primary outcome was success rate, while secondary outcomes were the time of bone healing, length of hospital stay, and associated injuries. Demographic data, type and nature of fracture, indication for surgery, healing time, operative time, complications of treatment, and time to implant removal were recorded. Results: Complete radiographic healing was achieved at a median of 7 weeks (IQR 6, 9). Most of the patients (n = 111; 84.1%) had fractures localized in the shaft of the tibia. The most common injuries were acquired by road traffic accidents (n = 42) and by a fall in the same level (n = 29), followed by injuries from sport activities (n = 21) or motorbike accidents (n = 18). Associated injuries were reported in 37 (28%) children. Fractures were closed in the majority of the children (n = 100; 76%), while 32 (24%) children presented with an open fracture. Children with open fractures were significantly older than children with closed fractures (13.5 years (IQR 10, 15) vs. 11 years (IQR 8.5, 14.5); p = 0.031). Furthermore, children with open fractures had a significantly longer hospital stay (7 days (IQR 5, 9) vs. 3 days (IQR 3, 6); p = 0.001), a higher rate of associated injuries (n = 14 (43.7%) vs. n = 23 (23%); p = 0.022), and a higher rate of postoperative complications (n = 7 (21.9%) vs. n = 8 (8%); p = 0.031). No intraoperative complications were recorded. A total of 15 (11.4%) postoperative complications were recorded. Most complications (60%) were minor complications, mostly related to the wound at the nail insertion site and were managed conservatively. A total of six (4.5%) patients required reoperation due to angulation of the fragments (n = 5) or refracture (n = 1). Conclusion: ESIN is a minimally invasive bone surgery technique and is a highly effective treatment for pediatric tibial unstable fractures with a low rate of complications. Based on the given results, surgical stabilization of the tibial fractures using titanium intramedullary nailing can be safely performed without casting with early physiotherapy.

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Elastic intramedullary nailing in unstable fractures of the paediatric tibial diaphysis: A systematic review

Cited by 18 publications

References 20 publications

Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails

Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails

Management of paediatric tibial fractures using two types of circular external fixator: Taylor spatial frame and Ilizarov circular fixator

Elastic Stable Intramedullary Nailing for Treatment of Pediatric Tibial Fractures: A 20-Year Single Center Experience of 132 Cases

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