Abstract
Purpose
The purpose of our study was to investigate the safety and efficacy of elastic stable intramedullary nailing for unstable pediatric tibial shaft fractures using titanium elastic nails (TENs). To our knowledge, this is the largest series reported in the literature of this specific fixation technique.
Methods
We reviewed all children with tibial shaft fractures treated operatively at our tertiary care children's hospital to find those patients who underwent fixation with TENs. Between 1998 and 2005, we identified 19 consecutive patients who satisfied inclusion criteria. The average age of the patients in our series was 12.2 years (range 7.2–16 years), and mean follow-up was 15.7 months (range 6–28 months). Patient charts and radiographs were retrospectively reviewed to gather the clinical data. Outcomes were classified as excellent, satisfactory, or poor according to the Flynn classification for flexible nail fixation.
Results
All patients achieved complete healing at a mean of 11.0 weeks (range 6–18 weeks). At final follow-up, mean angulation was 2° (range 0°–6°) in the sagittal plane and 3° in the coronal plane (range 0°–9°). Five patients (26%) complained of irritation at the nail entry site; there were no leg length discrepancies or physeal arrests as a result of treatment. Two patients required remanipulation after the index procedure to maintain adequate alignment. According to the Flynn classification, we had 12 excellent, six satisfactory, and one poor result.
Conclusion
Although the indications for operative fixation of pediatric tibial shaft fractures are rare, occasionally surgical treatment is warranted. Based on our results, elastic stable intramedullary nailing with titanium elastic nails is an effective surgical technique which allows rapid healing of tibial shaft fractures with an acceptable rate of complications.
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References
Shannak AO (1988) Tibial fractures in children: follow-up study. J Pediatr Orthop 8:306–310
Siegmeth A, Wruhs O, Vecsei V (1998) External fixation of lower limb fractures in children. Eur J Pediatr Surg 8:35–41
Tolo VT (1983) External skeletal fixation in children’s fractures. J Pediatr Orthop 3:435–442
Bar-On E, Sagiv S, Porat S (1997) External fixation or flexible intramedullary nailing for femoral shaft fractures in children. J Bone Joint Surg Br 79:975–978
Carey TP, Galpin RD (1996) Flexible intramedullary nail fixation of pediatric femoral fractures. Clin Orthop 332:110–118
Flynn JM, Hresko T, Reynolds RA, Blasier RD, Davidson R, Kasser J (2001) Titanium elastic nails for pediatric femur fractures––a multicenter study of early results with analysis of complications. J Pediatr Orthop 21(1):4–8
Metaizeau J (2004) Stable elastic intramedulary nailing of fractures of the femur in children. J Bone Joint Surg Br 86:954–957
Goodwin RC, Gaynor T, Mahar A, Oka R, Lalonde FD (2005) Intramedullary flexible nail fixation of unstable pediatric tibial diaphyseal fractures. J Pediatr Orthop 25(4):570–576
Kubiak EN, Egol KA, Scher D, Wasserman B, Feldman D, Koval KJ (2005) Operative treatment of tibial shaft fractures in children: are elastic stable intramedullary nails an improvement over external fixation? J Bone Joint Surg Am 87:1761–1768
O’Brien T, Weisman DS, Ronchetti P, Piller CP, Maloney M (2004) Flexible titanium elastic nailing for the treatment of the unstable pediatric tibial fracture. J Pediatr Orthop 24(6):601–609
Salem K, Lindemann I, Keppler P (2006) Flexible intramedullary nailing in pediatric lower limb fractures. J Pediatr Orthop 26(4):505–509
Ligier JN, Metaizeau JP, Prevot J, Lascombes P (1985) Elastic stable intramedullary pinning of long bone fractures in children. Z Kinderchir 40:209–212
Yuan P, Pring M, Gaynor T, Mubarak SJ, Newton PO (2004) Compartment syndrome following intramedullary fixation of pediatric forearm fractures. J Pediatr Orthop 24:370–375
Luhmann S, Schootman M, Schoenecker PL, Dobbs MB, Gordon JE (2003) Complications of titanium elastic nails for pediatric femoral shaft fractures. J Pediatr Orthop 23:443–447
Sink E, Gralla J, Repine M (2005) Complications of pediatric femur fractures treated with titanium elastic nails: a comparison of fracture types. J Pediatr Orthop 25:577–580
Moroz L, Launay F, Kocher MS, Newton PO, Frick SL, Sponseller PD, Flynn JM (2006) Titanium elastic nailing of fractures of the femur in children: predictors of complications and poor outcome. J Bone Joint Surg Br 88:1361–1366
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Sankar, W.N., Jones, K.J., David Horn, B. et al. Titanium elastic nails for pediatric tibial shaft fractures. J Child Orthop 1, 281–286 (2007). https://doi.org/10.1007/s11832-007-0056-y
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DOI: https://doi.org/10.1007/s11832-007-0056-y