Outcomes Using Titanium Elastic Nails for Open and Closed Pediatric Tibia Fractures

Abstract

The authors conducted a retrospective review at their level I trauma center to assess the outcomes of closed vs open pediatric tibial fractures treated with titanium elastic nails. The study group included 38 pediatric patients (median age, 12 years) treated with titanium elastic nails for tibial fractures during a 5-year period. Patient demographics, closed or open injury, Gustilo-Anderson type for open fractures, fracture location, skeletal maturity, time to union, hospital length of stay, number of procedures performed per patient, and complications were recorded. The main outcome measures were time to union and complications. Average follow-up duration was 13 months. Mean time to union was 4 months for closed and 9 months for open fractures (P<.001). Average time to union for type IIIA and IIIB fractures was significantly increased (11 and 12 months, respectively; P=.02). Delayed union (>6 months postoperatively) occurred in 1 (6%) of 17 closed fractures compared with 11 (52%) of 21 open fractures. The average number of surgical procedures for closed fractures was fewer than for open fractures (2 vs 3 procedures, respectively; P=.03). Mean hospital length of stay was shorter for closed than open fractures (3 vs 6 days, respectively; P=.03). Two infections occurred in the open fracture group. Closed and open pediatric tibial shaft fractures can be successfully treated with titanium elastic nails. Open fractures treated with titanium elastic nails have a significantly longer time to union, require additional operative procedures, and result in longer hospital stays.

Treatment of Closed Tibia Shaft Fractures in Children: A Systematic Review and Meta-Analysis

“…Of the excluded full texts, the most common reason for exclusion was that open fractures could not be separated (10 studies) [19][20][21][22][23][24][25][26][27][28] followed by studies with too small population (7 studies). [29][30][31][32][33][34][35] In two studies, 36,37 distal tibia fractures were no distinguishable from diaphyseal fractures, and two studies 38,39 reported only the incidence of compartment syndrome. Three additional studies reporting only epidemiological data, 40 surgical technique, 41 and long-term outcomes, 42 respectively, were excluded.…”

Fracture union in percutaneous Kirschner wire fixation in paediatric tibial shaft fractures

“…Clinical results are good; whichever treatment method is chosen but age is a consideration to define the best treatment 19, 20, 21, 22, 23, 24, 25. Closed reduction and plaster application is still the gold standard for tibial fractures in children.…”

“…Elastic stable intramedullary nailing is the gold standard for osteosynthesis of unstable diaphyseal fractures in children and adolescents 20, 27. In tibial fractures, indications for operative treatment are determined based on a variety of factors including fracture type, location, severity and patient age 22, 28. The encouraging results of elastic stable intramedullary nailing in femoral and forearm fractures led us to use this technique to treat tibial shaft fractures 29, 30.…”

Pediatric Tibial Shaft Fractures

“…The latter has advantages of not requiring pin site care, and both give access to the overlying leg tissue unless a cast is placed for rotational control or lack of cooperation. 19 Progressive weight bearing is allowed after 2–3 weeks with hip, knee, and ankle range of motion exercises from the outset. 16 17 Hardware is removed at 6–9 months, noting the temporary risk of refracture to warrant a delay in returning to full sporting activities.…”