Flexible intramedullary nails for unstable fractures of the tibia in children

Vallamshetla, V.R.P.; Silva, U. De; Bache, C. E.; Gibbons, Paul

doi:10.1302/0301-620x.88b4.17363

Cited by 72 publications

(78 citation statements)

References 21 publications

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“…Recently, flexible intramedullary nailing has become the preferred method for the treatment of tibial shaft fractures that require operative fixation [6,[8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

The incidence of compartment syndrome after flexible nailing of pediatric tibial shaft fractures

Pandya¹,

Edmonds

Mubarak

2011

Journal of Children's Orthopaedics

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Purpose Pediatric tibial shaft fractures are common injuries encountered by the orthopaedic surgeon. Flexible intramedullary nailing has become popular for pediatric patients with tibial shaft fractures that require operative fixation. The purpose of our study was to evaluate the incidence of, and the risk factors for, compartment syndrome (CS) after flexible intramedullary nailing of these injuries. Methods A retrospective review of tibial shaft fractures treated consecutively with flexible intramedullary nailing at our institution from 2003 to 2010 was performed. The incidence of CS after flexible nailing was recorded. In addition, age, weight, mechanism of injury, polytrauma, presence of an open fracture, presenting neurovascular exam, fracture pattern, delay in treatment ([24 h from injury), prior closed reduction attempts, method of reduction (open vs. closed) in the operating room, total fluoroscopy time, and operative time were recorded. Comparisons were made between children who developed CS and those who did not. Results Thirty-one children met inclusion criteria with a mean age of 11.2 years (range, 6.3-15.3 years); all were boys. Nearly, 20% of children developed CS after flexible nailing of their fractures. Those who developed CS after flexible nailing were heavier than the unaffected group (52.6 ± 14.5 kg vs. 39.4 ± 15.2 kg, P = 0.05); with a greater percentage of children 50 kg or greater (83.3% vs. 26.1%, P = 0.02) within the CS group. Children who developed CS were also more likely to present with neurologic deficits in the absence of compartmental swelling prior to surgery (66.7% vs. 9.1%, P = 0.009), and more likely to have comminuted/complex fracture patterns (83.3% vs. 29.1%, P = 0.02). There was no difference between patients who did and did not develop CS in regards to age (P = 0.42), high-energy injury mechanism (P = 0.30), polytrauma (P = 1.0), delay in treatment (P = 0.28), prior closed reduction attempts (P = 1.0), method of reduction (open vs. closed; P = 1.0) in the operating room, total fluoroscopy time (P = 0.96), and total operative time (P = 0.45). In addition, there was no difference (P = 0.65) in the rates of CS between children with open and closed fractures. Conclusions There is a high risk of CS after flexible intramedullary nailing of pediatric tibial shaft fractures regardless of whether an injury is open or closed. Variables that would seemingly be associated with the development of CS (high-energy injury mechanisms, polytrauma, treatment delay, prior closed reduction attempts, and closed reduction in the operating room) were not statistically associated with CS in our study. Clinicians should be wary for the development of CS whenever utilizing flexible nails for tibial shaft fractures, especially when the following co-morbidities are present: the child weighs greater than 50 kg, has complex/comminuted fracture patterns, or has a neurologic deficit in the absence of compartmental swelling prior to operative intervention.

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“…Recently, flexible intramedullary nailing has become the preferred method for the treatment of tibial shaft fractures that require operative fixation [6,[8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

The incidence of compartment syndrome after flexible nailing of pediatric tibial shaft fractures

Pandya¹,

Edmonds

Mubarak

2011

Journal of Children's Orthopaedics

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“…The search strategy revealed seven studies, all retrospective case series [6][7][8][9][10][11][12]. Three other studies were excluded due to their small patient numbers: Berger et al [13] reported results from nine patients, Salem et al [14] included five and Huber et al had one [15].…”

Section: Resultsmentioning

confidence: 99%

“…Vallamshetla et al [12] This case series assesses 56 unstable tibial fractures in 54 children treated during an 8-year period from March 1997 to May 2005. This study clearly defines the population with outcome measures of union, time to weight-bearing and function.…”

Section: O'brien Et Al [9]mentioning

confidence: 99%

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

Swindells

Rajan

2010

Journal of Children's Orthopaedics

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“…The search for treatment which satisfy most of these criteria has led to an increasing number of surgeons using the elastic intramedullary nails, to treat a variety of pediatric long bone fractures including the tibial shaft. 4,6,10 There are several advantages of this technique. Three-point fixation within the medullary canal allows maintenance of both alignment and rotation for most fractures.…”

Section: Discussionmentioning

confidence: 99%

Elastic Stable Intramedullary Nailing for Treatment of Pediatric Tibial Fractures

Gurung

Khatri

2016

J Lumbini Med Coll

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ABSTRACT:Introduction: Tibia fractures in the skeletally immature patient can usually be treated with above knee cast or patellar tendon bearing cast. The purpose of our study was to evaluate epidemiology and outcome of Elastic stable intramedullary nailing fixation of pediatric tibial shaft fractures treated at our institution. Methods: Over a period of one year, fifty pediatric patients of tibial shaft fractures, with average age of 9.68 yr (SD=2.37), were treated with elastic stable intramedullary nail. Demographic data, union and complication rate were evaluated. Results: There were 36 closed and 14 open fractures. The average time to union was 11.6 weeks (SD=2.65) for close and 14.3 weeks (SD=2.62) for open fracture. There were no instances of growth arrest, re-manipulations, or re-fracture. Conclusion: We conclude that flexible intramedullary fixation is an easy and effective method of management of both open and closed unstable fractures of the tibia in children.

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Flexible intramedullary nails for unstable fractures of the tibia in children

Cited by 72 publications

References 21 publications

The incidence of compartment syndrome after flexible nailing of pediatric tibial shaft fractures

The incidence of compartment syndrome after flexible nailing of pediatric tibial shaft fractures

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

Elastic Stable Intramedullary Nailing for Treatment of Pediatric Tibial Fractures

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